Academic literature on the topic 'Change management; Community Care Act 1990; NHS'

The chapter evaluates the reformed arrangements for the management and delivery of social care following the NHS and Community Care Act 1990 using a framework drawn from economic sociology. Research findings describing how a group of newly disabled older people fared as consumers of the services are summarized. An explanatory account is given drawing upon concepts and theory to be found in the growing literature on the sociology of economic life, particularly studies of consumption. The central conclusion is that it is difficult to account for the effects of the recent reforms on community care consumers without situating them within a context of existing social relations and institutions. If the reforms are to succeed they must change not just the practical mechanics of service funding and delivery but deeply embedded values and behavioural norms.

Aims and MethodThe Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia inpatients, prospective studies of inpatient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted.ResultsThe proportion of patients discharged to their own homes and to residential/nursing homecare remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 (P=O.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes.Clinical ImplicationsThe new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and hig her in-patient costs.

An important element in the NHS internal market, introduced by the national health Service and Community Care Act 1990, was the “NHS” contract — an agreement between purchasers and providers who were within the NHS but who were not in a direct management relationship to each other. The framers of the legislation intended that such contracts should be excluded from judicial enforcement and instead be subject to a special statutory dispute resolution procedure. This paper examines those factors which have impacted upon the resolution of NHS contractual disputes in practice drawing upon empirical research undertaken as part of an ERSC funded study.

Mental health services are of interest not only because of the large burden they impose, but also because they have been subject to more change than virtually any other type of health service over the past four decades. Although both the US and UK have taken to ‘deinstitutionalisation’ with enthusiasm, the US has so far proceeded somewhat further down that road than the UK. While both countries face similar problems, the NHS and Community Care Act 1990 may now lead to considerable further changes in the UK.

This article examines the issue of drawing medical consultants into managerial decision making. It commences by examining both historically and comparatively the influences on doctors and their reluctance to adopt managerial roles and responsibilities. It progresses to an analysis of the impact of the NHS and Community Care Act particularly in relation to the separation of purchaser and providers and the development of contracting mechanisms. The argument presented suggests that the rapid adoption of the clinical directorate model, as the favoured mode of organisation in acute units, has led to clinicians assuming ‘imitation’ general manager roles. The authors question whether this is the best use of the unique skills and time of clinicians. They compare with experience in the USA and propose that collaborative working between doctors and general managers is essential in health care. The article suggests a set of tasks for clinician managers and then dicusses the issues of training support and development which will be required if clinicians are to perform these tasks effectively.

The article considers the impact of the NHS and Community Care Act (1990), and the redefined role of `care manager', upon social work. It draws from a three-year ethnographic study of five area teams; one based in inner London and the others, including a hospital team, based in the north of England. Particularly it uncovers the considerable impact of intense bureaucracy, circumscribed budgets and the consequential removal of the care manager from the community. The article also questions any `seamless service' in work with other professionals and raises doubts as to whether need is even being partially met. Care managers are rarely able to utilize the skills that they develop during the Diploma in Social Work course. Frustration is felt on behalf of staff in the area office, who are now working under considerable strain, with little recognition, within what resembles a new emergency service. It is hoped the article is able to draw attention to the consequences of the continued deskilling of social work and retrenchment of what little remains of welfare.

BackgroundConcerns have been raised about the increase in the use of involuntary detentions under the Mental Health Act in England over a number of years, and whether this merits consideration of legislative change.AimsTo investigate changes in the rate of detentions under Part II (civil) and Part III (forensic) sections of the Mental Health Act in England between 1984 and 2016.MethodRetrospective analysis of data on involuntary detentions from the National Archives and NHS Digital. Rates per 100 000 population were calculated with percentage changes. The odds of being formally admitted to a National Health Service hospital compared with a private hospital were calculated for each year.ResultsRates of detention have at least trebled since the 1980s and doubled since the 1990s. This has been because of a rise in Part II (civil) sections. Although the overall rate of detentions under Part III (forensic) sections did not rise, transfers from prison increased and detentions by the courts reduced. The odds of being detained in a private hospital increased fivefold.ConclusionsThe move to community-based mental health services in England has paradoxically led to an increase in the number of people being detained in hospital each year, and in particular an inexorable rise in involuntary admissions. This is likely to be partly because of improved case finding with an increased focus on treatment and risk management, and partly because of changes in legislation. An increasing proportion of this government-funded care is being provided by private hospitals.Declaration of interestNone.

BackgroundThe needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings.ObjectivesThe EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005.DesignMixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, randomised controlled trials and research register development, with patient and public involvement built into all projects.SettingGeneral practices, community services, third-sector organisations and care homes in the area of the North Thames Dementia and Neurodegenerative Diseases Research Network local research network.ParticipantsPeople with dementia, their family and professional carers, GPs and community mental health team members, staff in local authority social services and third-sector bodies, and care home staff.Main outcome measuresDementia management reviews and case identification in general practice; changes in behavioural and psychological symptoms measured with the Neuropsychiatric Inventory (NPI); extent and impact of incontinence in community-dwelling people with dementia; mapping of pathways to death of people with dementia in care homes, and testing of a model of collaborative working between primary care and care homes; and understandings of the MCA 2005 among practitioners working with people with dementia.ResultsAn educational intervention in general practice did not alter management or case identification. Exercise as a therapy for BPSD did not reduce NPI scores significantly, but had a significant positive effect on carer burden. Incontinence is twice as common in community-dwelling people with dementia than their peers, and is a hidden taboo within a stigma. Distinct trajectories of dying were identified (anticipated, unexpected and uncertain), and collaboration between NHS primary care and care homes was improved, with cost savings. The MCA 2005 legislation provided a useful working framework for practitioners working with people with dementia.ConclusionsA tailored educational intervention for general practice does not change practice, even when incentives, policy pressure and consumer demand create a favourable environment for change; exercise has potential as a therapy for BPSD and deserves further investigation; incontinence is a common but unrecognised problem for people with dementia in the community; changes in relationships between care homes and general practice can be achieved, with benefits for people with dementia at the end of life and for the UK NHS; application of the MCA 2005 will continue to improve but educational reinforcements will help this. Increased research capacity in dementia in the community was achieved. This study suggests that further work is required to enhance clinical practice around dementia in general practice; investigate the apparent beneficial effect of physical activity on BPSD and carer well-being; develop case-finding methods for incontinence in people with dementia; optimise working relationships between NHS staff and care homes; and reinforce practitioner understanding of the MCA 2005.Trial registrationEVIDEM: ED-NCT00866099; EVIDEM: E-ISRCTN01423159.FundingThis project was funded by the Programme Grants for Applied Research programme of the National Institute for Health Research.

Objective: To review important events and predictions about pharmacy that have occurred in the practice since my career began and describe changes in opportunities that have developed over the past 35 years. Data Sources: I used personal recollections and information from the State of Florida Pharmacy Association journal over a 35-year period. Other supporting data were used to describe current practice opportunities. Data Synthesis: Over the past 35 years many people have predicted the demise of the pharmacy profession. The reasons stated for this demise have varied over the years and include government interference, the expansion of chain and mail-order pharmacies, managed care, loss of the compounding function, Medicaid reimbursement, national health insurance, and pharmacy technicians. Despite these gloomy predictions, community and hospital pharmacies have flourished over the past 35 years and new roles for pharmacists have emerged in managed care, consultant pharmacy, academic pharmacy, and the pharmaceutical industry. with the enactment of the Omnibus Budget Reconciliation Act of 1990 requirements, it appears that the public has even greater expectations from community pharmacists as medication advisors. The pharmacy profession is changing more rapidly than ever and pharmacists must prepare for these rapid changes. Colleges of pharmacy should inculcate in their students the importance of lifelong learning to keep abreast with change. Conclusions: Society will always need experts on drugs. Pharmacists must rise to the challenge and accept new and changing roles in drug therapy management. If that occurs the future of pharmacy will be ensured.

This work is an examination of contemporary public policy implementation. It seeks to isolate those features which need to be incorporated into implementation theory to assist in the analysis of the implementation of public policy The "new right" ideology requires that a particular organisational form be adopted by public implementing agencies. This form must reflect the need to introduce competition, the precepts of the "new managerialism" and to view the user of the public services as a "customer". These three elements will have a bearing on the process of the implementation. In particular, the need to regard the user of the services as a consumer implies that these users have an active part to play in the implementation process. The primary aim of the dissertation is to examine the nature and extent of the users involvement. A secondary aim seeks to develop and test a model of policy implementation which can incorporate the so called "top down" and "bottom up" perspectives of policy implementation. The model incorporates features which facilitate the analysis of contemporary policy implementation. These features include: the need to recognise the large amount of conflict and bargaining which is characteristic of multi - agency implementations, the dynamic and interactive nature of the process and the inclusion of the consumer as part of the process. The research uses the implementation of N.H.S. and Community Care Act (1990) in a shire county in order to examine these issues.

Social Services departments, created after the 1970 Local Authority Social Services Act, survived for nearly half a century. Their ability to meet the vision set out in the Seebohm Report was compromised by curtailment of expansion after the financial crisis in 1975. Their reputation was damaged by a number of widely reported child deaths in which social work was seen as passive and ineffective. Severe criticism followed when they were viewed as over active as in Cleveland and Orkney. As a result social services were seen as toxic in deprived communities. Despite winning responsibility for community care in the 1990 NHS and Community Care Act, departments suffered, first, from the requirement to spend the bulk of transferred social security funds in the independent sector and secondly from the prolonged squeeze on local government spending. The potential of care management for innovation and empowering service users was never fully realised.