Joyce Halliday

The emergent role of the link worker: a study in collaboration

Partnership working is integral to New Labours approach to modernising health and social care services for vulnerable groups such as children with complex needs. This paper draws on an initiative from Cornwall and the Isles of Scilly in which strategic and operational change have been promoted across the health and social care community in order to provide co-ordinated assessment and care for children with complex needs and their families. The introduction of link workers has been central, key contacts for families and professionals alike who are drawn from a wide range of backgrounds. The political imperative for partnership, combined with the commitment and commonality of purpose of front-line staff, has proved sufficient to facilitate inter-professional working without many of the enabling factors that are often regarded as important, such as co-location or parity of status. However, a number of organisational barriers to sustainability remain and the degree to which a strong operational lead can secure the necessary breadth of strategic resource allocation and support remains questionable.

Bridging the discursive gap between lay and medical discourse in care coordination

For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients oral narratives and medical sense-making; and whether a modified form of narrative medicine might mitigate them. We systematically compared 66 general practice patients own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012-13. Patients narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients viewpoints were never formally encoded, parts were lost when clinicians de-coded it, parts supplemented, and sometimes the whole narrative was re-framed. These discrepancies appeared to restrict the patient records utility even for GPs for the purposes of risk stratification, case management, knowing what other care-givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter-subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination.

A qualitative study of diverse providers' behaviour in response to commissioners, patients and innovators in England: research protocol

Introduction The variety of organisations providing National Health Service (NHS)-funded services in England is growing. Besides NHS hospitals and general practitioners (GPs), they include corporations, social enterprises, voluntary organisations and others. The degree to which these organisational types vary, however, in the ways they manage and provide services and in the outcomes for service quality, patient experience and innovation, remains unclear. This research will help those who commission NHS services select among the different types of organisation for different tasks. Research questions The main research questions are how organisationally diverse NHS-funded service providers vary in their responsiveness to patient choice, NHS commissioning and policy changes; and their patterns of innovation. We aim to assess the implications for NHS commissioning and managerial practice which follow from these differences. Methods and analysis Systematic qualitative comparison across a purposive sample (c.12) of providers selected for maximum variety of organisational type, with qualitative studies of patient experience and choice (in the same sites). We focus is on NHS services heavily used by older people at high risk of hospital admission: community health services; out-of-hours primary care; and secondary care (planned orthopaedics or ophthalmology). The expected outputs will be evidence-based schemas showing how patterns of service development and delivery typically vary between different organisational types of provider. Ethics, benefits and dissemination We will ensure informants organisational and individual anonymity when dealing with high profile case studies and a competitive health economy. The frail elderly is a key demographic sector with significant policy and financial implications. For NHS commissioners, patients, doctors and other stakeholders, the main outcome will be better knowledge about the relative merits of different kinds of healthcare provider. Dissemination will make use of strategies suggested by patient and public involvement, as well as DH and service-specific outlets.

Policy analytics need more than a spreadsheet: a case study in funding formulae

This article presents two case studies, concerning the allocation of £Billions by a mechanism communicated via spreadsheet models. It argues that technical analytic skills as well as policy development skills are a vital component of governance. In the UK, Central Government uses funding formulae to distribute money to local service providers. One commonly stated goal of such formulae is equity of service provision. However, given the complexity of public services, together with variations in need, delivery style and the exercise of stakeholder judgement as to which needs should be met and how, such formulae frequently obscure the process by which equity has been taken into account. One policy ‘solution’ to managing such tensions is to seek ‘transparency’. With respect to funding formulae, this commonly involves publishing the underlying data and formulae in spreadsheets. This paper extends the argument that such ‘transparency’ requires an audience that understands the policy assumptions (and related conceptualisations), data sources, methodological approaches and interpretation of results. It demonstrates how the search for policy ‘transparency’ is also met by the technical quality assurance goals that the operational research community would recognise as best practice in the development both of software generally and spreadsheet models specifically. Illustrative examples of complex formulae acting to subvert equity are drawn from the English Fire and Rescue Service and Police Service allocation formulae. In the former, an increase in the amount of deprivation, as measured by one of six indicators, has the perverse effect of decreasing the financial allocation. In the latter, metropolitan areas such as London are found to gain most from the inclusion of variables measuring sparsity. The conclusion from these scenarios is that the steps needed to for technical quality assurance and policy transparency are mutually reinforcing goals, with policy analysts urged to make greater use of technical analytic skills in software development.