Kirstein Rummery

Negotiating needs, access and gatekeeping: developments in health and community care policies in the UK and the rights of disabled and older citizens

This article argues that the cumulative consequences of community care policies in the UK have resulted in a move from universal access to NHS services to discretionary access to residual local authority services. Drawing on an empirical study of the experiences of disabled and older people in obtaining access to community care assessments, the article argues that the traditional ‘gatekeeping’ activities of professionals have been augmented by a range of managerial and bureaucratic gatekeeping procedures. It examines the implications of these additional layers of gatekeeping for disabled and older peoples status as citizens.

Partnerships, performance and primary care: Developing integrated services for older people in England

The development of health services in England is currently shaped by three key factors: the active involvement of front-line health professionals (particularly family doctors – general practitioners) in decisions about resource allocation and service development priorities; the promotion of ‘partnerships’ between health and other organisations in order to deliver ‘joined-up’ services; and the close performance management of organisations and professionals to ensure that they meet externally prescribed objectives and targets. This paper considers the implications and impact of these factors on the development of services for older people. It discusses whether, under these circumstances, health service developments are likely to address some of the most pressing needs of older people.

Access to services as a civil and social rights issue: The role of welfare professionals in regulating access to and commissioning services for disabled and older people under new labour

This paper draws up a theoretical framework of citizenship, based on Marshall’s thesis, that encompasses the idea of access to welfare services (using the example of community care services for disabled and older people) as a civil and social rights issue. The authors critically examine current policy developments in the NHS and local authorities under New Labour that emphasize partnership, particularly the proposals and provisions made in ‘The New NHS’ and ‘Partnership in Action’. Their theoretical framework is used to explore issues concerning access to and the commissioning of health and social care services under New Labour. They conclude that the role of welfare professionals, particularly GPs and social services workers, and their relationships with service users, patients, carers and their families under New Labour presents a continuing challenge to the citizenship status of disabled and older people.

Governance and Collaboration: Review Article

Rod Rhodes (1997) Understanding Governance: Policy Networks, Governance, Reflexivity and Accountability , Open University Press 1997. Gerry Stoker (1998) ‘Governance as theory: five propositions’, International Journal of Social Sciences 50 , 1, 17–28. Helen Sullivan and Chris Skelcher (2002) Working across Boundaries: Collaboration in Public Services , Palgrave. Janet Newman, Marion Barnes, Helen Sullivan, and A. Knops (2004) ‘Public participation and collaborative governance’, Journal of Social Policy 33 , 203–223. From a term used largely within political science in the mid-1990s, ‘governance’ has become a key conceptual and analytical convention adopted by social policy, largely because of its usefulness in examining questions that are key to the discipline: citizenship; welfare rights and responsibilities; accountability; legitimacy and partnership working. Clarence and Painter (1998) have constructed a useful characterisation of public policy, identifying a shift in emphasis from hierarchies, to markets and now to collaboration. Networks, ‘joined up’ governance and partnership working are now central in both policy practice and analysis. These processes are not new, but New Labour have clearly expanded and accelerated them. For New Labour, collaborative working is now perceived as central in their response to key policy challenges: improving public services, tackling social exclusion and revitalising local democracy. These processes are now evident at all levels of policy making from supranational organisations such as the European Union down to neighbourhood-based initiatives. It appears that we are moving from the closed, unitary system of government of the Westminster model to a more open, decentralised system of governance. Our conceptions of citizenship have accordingly shifted, from one based on representation to one based on active participation, particularly within local communities. Governance is an issue which concerns all levels of government and citizen participation, from international-level World Bank concerns about commitment to efficiency and accountable government, to highly devolved localised urban regeneration partnerships.

The way forward for joint working? Involving primary care in the commissioning of social care services

This article explores the different ways in which GPs and the primary health care team (PHCT) are involved in working together with social services in the planning, commissioning and purchasing of social care services for individuals or groups of patients in the UK. Seven sites were identified following a literature search of mainstream and ‘grey’ joint commissioning literature. Interviews were carried out with key stakeholders from health and social care purchasing agencies in each site, describing the organisation of primary care involvement in commissioning social care services. The level of involvement in commissioning services varied according to the model of commissioning adopted by the sites. Locality/area-based commissioning offered the PHCT the opportunity to be involved in the strategic planning of health and social care. Practice-based commissioning offered the PHCT the opportunity to commission specific services for their practice population. Commissioning for individuals widened the skills ba...

Social services representation in primary care groups and trusts

Against a rapidly changing policy backdrop, health providers and social services departments in England are attempting to develop partnerships in order to effectively provide services. Relations between health and social care organisations have long been recognised as being problematic, in terms of historically poor relationships between GPs and social services departments and the non-coterminous natures of many organisational boundaries. The development of Primary Care Groups and Trusts has provided an opportunity to try to overcome some of these problems. This paper draws on a national survey of a sample of Primary Care Groups/Trusts and associated in-depth case studies to describe the roles of the social services representatives on Primary Care Group Boards/Trust Executive Committees and discusses the extent to which closer collaboration in the development of services is occurring and its potential for development in the future. It highlights the importance of greater organisational stability and the need for time to form effective partnership arrangements in the future.

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.