Jo Ellins

Effectiveness of strategies for informing, educating, and involving patients

Evidence that strategies to strengthen patient engagement are effective is substantial, argue Angela Coulter and Jo Ellins, but any strategy to reduce health inequalities must promote health literacy

Opening up the primary medical care market.

By the end of March every primary care trust in England should have commissioned a new health centre. Jo Ellins, Chris Ham, and Helen Parker examine the effect of this attempt to open up the market

“You don't know what you are saying ‘Yes’ and what you are saying ‘No’ to”: hospital experiences of older people from minority ethnic communities

ABSTRACT Improving responsiveness to the needs of older people from minority ethnic communities has been emphasised as a goal in England since the publication of the National Service Framework for Older People in 2001. Despite this, people from minority ethnic groups consistently give poorer ratings of their health services than ‘majority’ populations, both in England and across many other health-care systems. Language barriers have been shown to play a particularly important role, and appear to be a stronger predictor of perceived quality of care than ethnic origin per se. This paper reports findings from a larger study exploring older peoples experiences of care transitions, focusing on the findings from one case study area which explored the hospital and discharge experiences of older people from minority ethnic communities. A participatory approach was adopted, with older people from the local area collaborating in the design, delivery and analysis of the research as ‘co-researchers’. Twenty-four in-depth narrative interviews were carried out with people who had experienced a recent hospital stay as a patient or a family member providing care and support. Our findings show that many aspects of the hospital experience, including the desire for personalised and humanistic approaches to care, are important to older people irrespective of ethnic background. However, older people from minority ethnic communities can also face language and cultural barriers which negatively affect the quality and experience of care. People who had limited English proficiency struggled to understand, communicate and participate in their care. Where professional services were not available or requested, interpreting was provided informally by other patients, family members, hospital staff in clinical and domestic roles, or not at all. We conclude that targeted strategies are required to ensure appropriate and effective hospital services for a multicultural population.

Employee ownership in the NHS

Mutual models may help to deliver higher levels of performance

Together we are better? Strategic needs assessment as a tool to improve joint working in England

Purpose – This paper seeks to report the results of a national survey to explore preparations under way by local authorities and primary care trusts (PCT) for the duty to conduct a joint strategic needs assessment (JSNA), key barriers and enablers to this, and the implications for future policy. In particular, the study focuses on JSNA in the context of current and future health and social care partnerships.Design/methodology/approach – Using Department of Health e‐mail circulation lists, the authors conducted a national survey of all PCT chief executives, directors of adult social services and public health in England (a total of 459 people). A qualitative survey was e‐mailed in February 2008 at the time when health and social care communities were preparing to implement the new duty. All completed surveys were analysed by both authors using thematic content analysis. A grounded approach was taken whereby the thematic framework emerged from initial familiarisation with the data, to which any further them...

The theory and practice of markets in health care.

The arguments for using choice and competition as a strategy of health care reform have been articulated most clearly and cogently by Le Grand. In a series of publications, he has developed an idea originally set out over a decade ago, based on an analysis of the knightly and knavish behaviours of the providers of public services, into a full blown argument for the application of market principles in public services. His preference for markets derives from the need to counteract the risks of self-interested behaviour by providers, the middle-class bias of reforms that rely on articulate users expressing their preferences, and the disempowerment that results from over-reliance on ‘command and control’ as a way of allocating health services. An empirical test of these ideas is currently underway in primary care in England. To address concerns about lack of primary care capacity in some areas and services that are not accessible to patients at convenient times in others, the government has encouraged commissioners (Primary Care Trusts) to use the powers available to them to invite bids from new providers to enter the primary care market. In practice, commissioners were slow to respond to this encouragement, and as a consequence, the Equitable Access to Primary Care programme was launched in 2007. The programme is described by the Department of Health as a ‘national programme of local procurements’. This means that Primary Care Trusts manage the procurements, working either on their own or in regional groupings, but they do so within a national framework. Under the programme, which is supported by £250 million of additional public funding, the Department of Health has required every Primary Care Trust to commission a new general practitioner (GP)-led health centre. A further 113 new general practices are being procured in the 50 areas of England with most need for additional capacity. While procurements under the programme are still underway, an indication of the nature of the emerging primary care market can be gleaned from a survey conducted during 2008. The survey involved interviews with all 10 regional bodies (Strategic Health Authorities) in England to gather information about their experience. In addition, Primary Care Trusts identified as being actively involved in procuring new primary care capacity were interviewed, as were a selection of providers bidding for contracts. The size and competitiveness of the market varied between areas with some commissioners reporting substantial interest and others reporting a limited response to invitations to tender. A number of different types of provider were bidding for contracts. These included local general practices, GP-led companies and corporate providers. A recurring theme was whether the ‘playing field’ between different types of provider was truly level. On the one hand, corporate providers were concerned about lack of access to the public sector pension scheme for their staff, while local general practices felt disadvantaged in taking on the complex documentation involved in the procurement. For their part, commissioners were sensitive to the obstacles faced by local general practices, but were hampered in their ability to provide support by the need to ensure fair and consistent treatment of all providers bidding for contracts. The survey also found that the procurement process was timeand resource-intensive. Consistent with other evidence, Primary Care Trusts were reported to be struggling to act as effective commissioners of new services. This was illustrated by the variability and accuracy of the information they supplied to organizations bidding for contracts and their inexperience in specifying the service model they wished to procure. Commissioners also lacked some of the technical expertise needed in undertaking procurements, so in many cases they were collaborating in regional groupings to address this. One of the major uncertainties in extending choice and competition to primary care in the English NHS is whether patients will use the new services that are commissioned. The source of this uncertainty is, in part, the high level of satisfaction with existing primary care services, and, in part, the limited efforts put into informing patients of the choices available to them and how they can move from one practice to another. Government policy appears to be founded on a belief, to adapt a phrase from a related context, that, ‘if you build it they will come’, but as yet it is not clear that this will be the case. There is, therefore, a risk that unless more is done to stimulate patient choice, new services will be under-used and offer poor value to government and in turn, the taxpayer. If this happens, then it can be predicted that policymakers will seek to change the terms of the debate and argue that, by promoting choice and competition, they have succeeded in encouraging existing providers to extend their opening hours, thereby becoming more responsive to patients. This has already started to happen with over 70% of practices in England offering extended opening hours by the end of February 2009. In reality, the willingness of practices to do this has