Combining and integrating life /social sciences and citizen trainers in Nurse Education - a N. Ireland initiative

Before commencement of the academic year 2012/2013 the social sciences, public health and the biomedical sciences were taught to separate modules. This reinforced the idea off separate disciplines certainly for some of the younger students and a failure to appreciate the interconnectedness (whole person) perspective on health; separately modules taught and assessed in separate silos. There was limited understanding by the lecturers of the other areas that they were not teaching to -reflecting perhaps a dis-coordinated approach to health sciences (Mason and Whitehead 2003). As a result of significant discussion and interdisciplinary negotiation the life, social sciences public health/ health education were drawn together in the one module for the academic year 2012/13. The module provides the undergraduate students with an introduction to an understanding of Life Sciences, psychology, sociology and public health and their contribution within the context of nursing and midwifery. Each week’s teaching seeks to reflect against the other module delivered in first year - addressing clinical skills. The teaching is developing innovative e-learning approaches, including the use of a virtual community. The intention is to provide the student with a more integrated understanding and teaching to the individual’s health and to health within a social context (Lin 2001; Iles- Shih 2011). The focus is on health promotion rather than disease management. The module runs in three phases across the student’s first-year and teachers to the field of adult mental health, learning disability, children’s nursing and the midwifery students -progressively building on the student’s clinical experience. The predominant focus of the module remains on health and reflecting aspects of life and social life within N. Ireland. One of the particular areas of interest and an area of particular sensitivity is engaging the students to the context of the Northern Ireland civil unrest (the Troubles); this involves a co-educational initiative with service users, only previously attempted with social work students (Duffy 2012). The service users are represented by WAVE an organisation offering care and support to bereaved, traumatised or injured as a result of the violent civil conflict `the Troubles’. The `Troubles’ had ranged over an extended period and apart from the more evident and visual impact of death and injury, the community is marked by a disproportionate level of civil unrest, the extremes of bereavement, imprisonment, displacement antisocial behaviour and family dysfunction (Coulter et al. 2012). As co-educators with the School of Nursing and Midwifery, WAVE deliver a core lecture (augmented by online material), then followed by tutorials. The tutorials are substantially led by those who had been involved with and experienced loss and trauma as a result of the conflict (Health Service users) as `citizen trainers’ and provide an opportunity for them to share their experience and their recollection of personal interaction with nursing and midwifery students; in improving their understanding of the impact of `The Troubles’ on patients and clients affected by the events (Coulter et al. 2012) and to help better provide a quality of care cognisant of the particular needs of those affected by `the Troubles’ in N.Ireland. This approach is relatively unique to nursing in N. Ireland in that it involves many of those directly involved with and injured by the `Troubles’ as `citizen trainers’ and clearly reflects the School’s policy of progressively engaging with users and carers of nursing and midwifery services as co-educators to students (Repper & Breeze 2006). Only now could perhaps such a sensitive level of training to student nurses and midwives be delivered across communities with potential educative lessons for other communities experiencing significant civil unrest and sectarian conflict.

Risk in Private Finance Initiative Projects::A Public Sector Perspective

The management of public sector risk is increasingly seen as a priority area of UK government policy. This has been highlighted recently by the Prime Minister Gordon Brown who stated that “the issue of public risk is one of the most challenging areas of policy-making for any government” (Strategic Risk, 2008). In response to these challenges, the UK Prime Minister has appointed a new body - the Risk and Regulation Advisory Council (RRAC) which is tasked with improving the way risk to the public is understood and managed. One area of particular concern with regard to the governance of public sector risks involves projects procured via the Private Finance Initiative (PFI). These projects involve long-term contracts, complex multi-party interactions and thus create various risks to public sector clients. Today, most PFI actors acknowledge the potentially adverse effects of these risks and make an effort to prevent or mitigate undesirable results. As a consequence, issues of risk allocation, risk transfer and risk management have become central to the PFI procurement process. This paper provides an overview of the risk categories and risk types which are relevant to the public sector in PFI projects. It analyses risk as a feature of uncertain future project-related events and examines potential pitfalls which can be associated with PFI risk management on the basis of a case study of a high-profile PFI hospital in Scotland. The paper concludes that, despite the trend towards diminished risk profiles during the operational phase, the public sector continues to be exposed to significant risks when engaging in PFI-based procurement.

Does the UK Local Finance Improvement Trust (Lift) Initiative Improve Risk Management in Public-Private Procurement?

The UK government introduced the Private Finance Initiative (PFI) and, latterly, the Local Improvement Finance Trust (LIFT) in an attempt to improve public service provision. As a variant of PFI, LIFT seeks to create a framework for the effective provision of primary care facilities. Like conventional PFI procurement, LIFT projects involve long-term contracts, complex multi-party interactions and thus create various risks to public sector clients. This paper investigates the advantages and disadvantages of LIFT with a focus on how this approach facilitates or impedes risk management from the public sector client perspective. Our paper concludes that LIFT has a potential for creating additional problems, including the further reduction of public sector control, conflicts of interest, the inappropriate use of enabling funds, and higher than market rental costs affecting the uptake of space in the buildings by local health care providers. However, there is also evidence that LIFT has facilitated new investment and that Primary Care Trusts (PCTs) have themselves started addressing some of the weaknesses of this procurement format through the bundling of projects and other forms of regional co-operation.

The COMET initiative database: progress and activities update (2014)

The COMET Initiative database is a repository of studies relevant to the development of core outcome sets (COS). Use of the website continues to increase, with more than 16,500 visits in 2014 (36 % increase over 2013), 12,257 unique visitors (47 % increase), 9780 new visitors (43 % increase) and a rise in the proportion of visits from outside the UK (8565 visits; 51 % of all visits). By December 2014, a total of 6588 searches had been completed, with 2383 in 2014 alone (11 % increase). The growing awareness of the need for COS is reflected in the website and database usage figures.

The role of the National Audit Office in Private Finance Initiative endurance

The Private Finance Initiative (PFI) has become one of the UK’s most contentious public policies. Despite New Labour’s advocacy of PFI as a means of achieving better value for money, criticisms of PFI have centred on key issues such as a lack of cost effectiveness, exaggerated pricing of risk transfers, excessive private sector profits, inflexibility and cumbersome administrative arrangements. Nevertheless, PFI has persisted as a key
infrastructure procurement method in the UK and has been supported as such by successive governments, as well as influencing policy in the Republic of Ireland and other European Nations. This paper explores this paradoxical outcome in relation to the role played in the UK by the National Audit Office (NAO). Under pressure to justify its support for PFI, the Blair government sought support for its policies by encouraging the NAO to investigate issues relating to PFI as well as specific PFI projects. It would have been expected that in fulfilling its role as independent auditor, the NAO would have examined whether PFI projects could have been delivered more efficiently, effectively or economically through other means. Yet, in line with earlier research, we find evidence that the NAO failed to comprehensively assess
key issues such as the value for money of PFI projects, and in so doing effectively acted as a legitimator of PFI policy. Using concepts relating to legitimacy theory and the idea of framing, our paper looks into 67 NAO private finance reports published between 1997 and 2011, with the goal of identifying the preferences, values and ideology underpinning the
NAO’s view on PFI during this period. Our analysis suggests that the NAO sought to legitimise existing PFI practices via a selective framing of problems and questions. Utilising a longitudinal approach, our analysis further suggests that this patterns of selective framing persisted over an extended time period during which fundamental parameters of the policy (such as contract length, to name one of the most important issues) were rarely addressed.
Overall the NAO’ supportive stance toward PFI seems to have relied on 1) a focused on positive aspects of PFI, such as on time delivery or lessons learned, and 2) positive comments on aspects of PFI that were criticised elsewhere, such as the lack of flexibility of underlying contractual arrangements. Our paper highlights the possibility that, rather than providing for a critical assessment of existing policies, national auditing bodies can
contribute to the creation of legitimatory environments. In terms of accounting research we would suggests that the objectivity and independence of accounting watchdogs should not be taken for granted, and that instead a critical investigation of the biases which can characterise these bodies can contribute to a deeper understanding of the nature of lobbying networks in the modern state.