Sarah Mosedale

Regulation, Markets and Poverty

Regulation, Markets and Poverty incorporates the main policy implications arising from theoretical and empirical research into competition, regulation and regulatory governance in developing countries. This analysis often challenges conventional wisdom and draws on the work of leading experts from a range of disciplines.

What is the impact of flexicurity on the chances of entry into employment for people with low education and activity limitations due to health problems? A comparison of 21 European countries using Qualitative Comparative Analysis (QCA)

BackgroundEmployment and unemployment are key determinants of health inequalities and should be a priority when discussing policies to reduce such inequalities. Our aim is to investigate how flexicurity policies across European countries impact on the employment chances for people with low education and activity limitations.MethodsThe longitudinal EU-SILC dataset, pooled 2005–2010, was used to calculate labour market outcomes. The sample consisted of 25 countries and 19,881 individuals. The employment transitions of non-employed people with activity limitations was followed from one year to the next, and the outcomes were rates of return-to work (RTW) among those with low education, and relative equality of RTW between those with low and high education (rate ratio, RR).Data on flexicurity policy and labour market factors were accessed from Eurostat and the OECD. As policy data was only available for OECD countries, the sample was reduced to 21 countries. Fuzzy-set QCA (Qualitative Comparative Analysis) was used to examine how different combinations of the components of flexicurity were linked to the two outcomes.ResultsWhere high rates of RTW were achieved, high employment rates were always present. In five countries (the Nordic countries and the Netherlands) these factors coexisted with high expenditure on active labour market policies and social services in old age. In three others (The Czech Republic, UK and Estonia) they were combined with low employment protection and low benefit expenditure. For equality in RTW, low unemployment rates were combined with either high benefit expenditure, or low employment protection.ConclusionWe found two routes that lead to high RTW: we characterise these as the high road and the low road. Taking the low road (relaxing employment protection and limiting benefits) may be a tempting option for poorly performing countries. However, without measures to stimulate female employment it may not be enough as high overall employment is so important in enabling people with activity limitations to access the labour market. To achieve equality in RTW, it seems that as long as unemployment is low, either flexibility or security is sufficient.

SAPC hot topic: the changing primary care research landscape

What do the extensive English NHS reforms mean for primary care research? How can we best take advantage of the new opportunities that will arise – and avoid being blindsided by any threats or confusions? One obvious imperative is to keep up-to-date with the changes and share ideas with colleagues and this Hot Topic aims to contribute to just those sorts of thought processes and conversations. There are reasons to be cautiously optimistic. It seems clear that the government recognises the key role of research in the NHS. In November 2012, it published the first Mandate to the NHS Commissioning Board (Department of Health (DoH), 2012a), a mandate that the Board is legally required to follow. This contains a clear directive to promote and support participation by NHS organisations and patients in research. Importantly, particularly in the current climate, the Mandate spells out the significance of research not only for patient outcomes but also for economic growth. Making a success of partnership with public sector bodies, specifically including universities, is also stated as an objective for the Board. Developments in terms of the NHS Constitution are also heartening. The Constitution is a ‘declaratory document’: it brings together the principles, values, rights and responsibilities that underpin the NHS. Because of its enduring nature, the Constitution is not amended without a ‘clear and compelling’ reason to do so (DoH, 2012b: 3). Nevertheless, the government is proposing to add not only a commitment to the ‘use’ of research (as well as its conduct and promotion) but also a new pledge to invite patients to participate in research. The new commitment to using research will be welcomed by members of the academic primary care community as an opportunity to further develop their knowledge exchange practices. Both the Board and clinical commissioning groups (CCGs) also have a duty to promote awareness of the Constitution among patients, staff and the wider public. This raising of the profile of research in the Constitution is consistent with the unprecedented duties and powers, which the Health and Social Care Act (2012) gave to the Secretary of State and to CCGs that must now ‘promote (a) research on matters relevant to the health service and (b) the use in the health service of evidence obtained from research’. Furthermore, research is no longer restricted to ‘any matters relating to the causation, prevention, diagnosis or treatment of illness’ but may also now encompass ‘any such matters connected with any service provided under this Act as the Secretary of State, the Board or the clinical commissioning groups (as the case may be) considers appropriate’. Local authorities, too, can conduct, commission or help with the research ‘for any purpose’ connected with their work in relation to the health service. The NHS Outcomes Framework, which will be part of the accountability mechanism for the Board, also identifies research and the use of research evidence in the design and delivery of services at a local level as a ‘vital area’ (DoH, 2012c). Therefore, both nationally and locally, the mood music is encouraging and opportunities for innovative research look likely to arise. However, no paranormal abilities are required to identify potential pitfalls. Major organisational upheavals and their accompanying staff migrations always bring with them the possibility of disruptive corporate memory loss and how such changes will Correspondence to: Professor Paul Wallace, Clinical Director, Primary Care Research Network Coordinating Centre, 43 Whitfield Street, London W1T 4HD, UK. Email: paul. wallace@nihr.ac.uk