National evaluation of NHS genetics service investments: emerging issues from the cancer genetics pilots

In seeking to fulfil the ambition of the 2003 genetics white paper, Our Inheritance, Our Future, to ‘mainstream’ genetic knowledge and practices, the Department of Health provided start-up funding for pilot services in various clinical areas, including seven cancer genetics projects. To help to understand the challenges encountered by such an attempt at reconfiguring the organization and delivery of services in this field, a programme-level evaluation of the genetics projects was commissioned to consider the organizational issues faced. Using a qualitative approach, this research has involved comparative case-study work in 11 of the pilot sites, including four of the seven cancer genetics pilots. In this paper, the researchers present early findings from their work, focusing in particular on the cancer genetics pilots. They consider some of the factors that have influenced how the pilots have sought to address pre-existing sector, organizational and professional boundaries to these new ways of working. The article examines the relationship between these factors and the extent to which pilots have succeeded in setting up boundary-spanning services, dealing with human-resource issues and creating sustainable, ‘mainstreamed’ provision which attracts ongoing funding in a volatile NHS commissioning environment where funding priorities do not always favour preventive, risk-assessment services.

Emerging Gender Regimes and Policies for Gender Equality in a Wider Europe

This article addresses some implications for gender equality and gender policy at European and national levels of transformations in family, economy and polity, which challenge gender regimes across Europe. Women’s labour market participation in the west and the collapse of communism in the east have undermined the systems and assumptions of western male breadwinner and dual worker models of central and eastern Europe. Political reworking of the work/welfare relationship into active welfare has individualised responsibility. Individualisation is a key trend west − and in some respects east − and challenges the structures that supported care in state and family. The links that joined men to women, cash to care, incomes to carers have all been fractured. The article will argue that care work and unpaid care workers are both casualties of these developments. Social, political and economic changes have not been matched by the development of new gender models at the national level. And while EU gender policy has been admired as the most innovative aspect of its social policy, gender equality is far from achieved: women’s incomes across Europe are well below men’s; policies for supporting unpaid care work have developed modestly compared with labour market activation policies.Enlargement brings new challenges as it draws together gender regimes with contrasting histories and trajectories. The article will map social policies for gender equality across the key elements of gender regimes – paid work, care work, income, time and voice – and discuss the nature of a model of gender equality that would bring gender equality across these. It analyses ideas about a dual earner–dual carer model, in the Dutch combination scenario and ‘universal caregiver’ models, at household and civil society levels. These offer a starting point for a model in which paid and unpaid work are equally valued and equally shared between men and women, but we argue that a citizenship model, in which paid and unpaid work obligations are underpinned by social rights, is more likely to achieve gender equality.