Debating the division of labour in healthcare in France and England

As Larson (1990) states, professions are historically specific and ‘there is no pattern of social closure around an occupation that is not inflected by the latter’s past, its specific activity and typical context of performance or…the political context in which closure is obtained.’ Larson’s work focuses particularly on the differences between the establishment of professions in France, where there was considerable state intervention, with that in the US and UK, both of which were more market-oriented. This paper is based on data from an evaluation of a large European exchange programme of staff between Kent and Lille, from 2005 to 2008 and discusses the division of labour in healthcare between two occupational groups, medicine and nursing, in England and in France. This division of labour has been extensively discussed in the UK, particularly since from the mid 1990s the nursing role has been extended and innovations such as nurse prescribing have been introduced, whereas such extended roles have not been introduced in France. The paper draws particularly on interview data from mental health practitioners, in which it is argued that whilst the English nurses may on the surface seem to have a wider range of competences and autonomy, in reality they are more constrained, as they operate under protocols and therefore do not exercise professional judgement. Not only do these data illustrate the centrality of professional judgement in discussions about practice, they also demonstrate the circularity of many debates on extended roles.

Putting down routes: an examination of local government cultural policy shaping the development of heritage trails

This paper explores the significance of trails within local government cultural strategies by presenting the results of an audit of 1000 trails, content analysis of local cultural strategies and a series of interviews with local government cultural officers. It highlights the growing sophistication of trails as flexible and multi-faceted products promising an array of social, environmental, cultural and economic benefits. However, key issues emerge as challenges for local government cultural officers. These include the need for a realistic assessment of the relative importance of competing rationales, the design of methodologies to enable evidence-based policy making and more effective engagement with commercial organisations.

Policy packages as potential routes to urban road pricing in the UK

This paper focuses on urban road pricing as a demand management policy that is often regarded as radical and generally unacceptable. Road pricing often gets delayed or abandoned due to low acceptability. This may be due to the fact that complex interactions and drivers of change affect road transport management and require cooperation within implementation networks. The implementation network is a group of people (referred to as partners and actors) who co-ordinate the introduction of policy tools. The drivers of change include any internal or external influences that have an effect on the time, place, or ‘shape’ of the policy measures being introduced. Demand management measures that focus on 'sustainable transport' usually address a limited set of objectives and are often implemented alone i.e. are not necessarily combined with other policy measures. When combined with other measures, it is not always clear whether the multiple interactions between policy tools and implementation networks have been sufficiently considered. Examples of ongoing implementation of policy package in the UK are the support of road pricing initiatives combined with public transport improvements by the Transport Innovation Fund. The objectives of the paper are twofold. First, we present a review of the UK urban road pricing situation. Second, we contrast the emerging issues against six key implementation factors. The analysis of three existing UK road pricing examples - London, Edinburgh and Durham – shows the importance of combining policy tools. Furthermore, through the above examples and theoretical arguments, we emphasise the additional need of creating and maintaining strong networks when implementing policy packages.

Social policy for nurses and the helping professions

The book examines the relationship between welfare and health and includes discussion of key policy issues such as; changes in health care delivery, regulation of professionals, privatisation, welfare pluralism and the tackling of health and social inequalities. The significance of social policy in preventing ill health and disability, as well as supporting the sick and disabled people, is emphasised throughout the book.

Challenges to Slovakia and Poland health policy decisions: use of investment treaties to claim compensation for reversal of privatisation/liberalisation policies

Investment treaties, and possibly the EU Treaty itself, are being used by multinational companies Penta and Eureko to try and force the Slovak government to pay compensation for reversing health privatisation and liberalisation policies. Similar action has been used against the Polish government by Eureko to win compensation worth nearly 2 billion Euros and a policy commitment to further privatisation.