989 resultados para innovations de service


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The purpose of this research note is to demonstrate how an individualised quality of life instrument could be adapted to provide a more accurate estimate of the impact of a social service on a person’s quality of life. An increase in quality of life between the start and end of a service is often taken as an indication that the service impacted positively on quality of life. The modifications to the quality of life instrument suggested in this paper show that this assumption is not always accurate and should be questioned directly.

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Current policy and practice emphasises much more than ever before a need for purchasers and providers to reduce appropriately the length of hospital stay. Consequently, a number of early discharge “schemes” have been developed. This paper presents the findings from an evaluation of a “home from hospital” (HFH) scheme. The HFH service provides a maximum of six weeks intensive domiciliary care for older people on their discharge from hospital. The aim of the service is to facilitate early discharge from hospital and to assist patients to regain independence. The study reported here elicited the views and perceptions of clients and professionals involved in the HFH scheme about the quality, efficiency and effectiveness of the service. Seventy-five clients were discharged from hospital to the HFH scheme during a two month period and those who consented to participate in the study were interviewed after discharge from the HFH service (n = 40). Participants had attended hospital for various conditions but the largest group were fracture patients. Hospital staff and community based professionals completed a questionnaire about the service. Overall, clients and professionals perceived the HFH scheme as a beneficial service, though some minor problems existed at an individual level. Clients’ dependency levels generally decreased during their time on the scheme. Research using a controlled design is necessary in order to draw firm conclusions about the cost-effectiveness of a HFH service. Overall, home-from-hospital appears to be an effective model of an early discharge scheme worthy of further attention.

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This paper reports the results of an investigation, by postal questionnaire, of the views of 30 General Practitioners about a model of out of hospital care – the home from hospital (HFH) service, which mainly provides social care and rehabilitation for patients in their own home. The GPs, who all worked within one of the Health and Social Services Board areas in Northern Ireland during the time of the study (March-April 1998), indicated that the introduction of the HFH service, unlike other models of out of hospital care, did not increase their workload. Therefore, it is suggested that the HFH model of care should be given more attention in terms of research evaluation and service development.

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The sense of place that relates human beings to their environment is under threat from the rising tide of placelessness which can result from potentially positive forces such as urban regeneration as well as negative ones such as incremental degradation. The concept of sense of place, and the need to protect and enhance special places, has underpinned UK conservation legislation and policy in the post-war era. In Northern Ireland, due to its distinctive settlement tradition, its troubled political circumstances and its centralised administrative system, a unique hierarchy of special places has evolved, involving areas of townscape and village character as well as conventional conservation areas. For the first time a comprehensive comparative survey of the townscape quality of most of these areas has been carried out in order to test the hypothesis that too many conservation area designations may devalue the conservation coinage. It also assesses the contribution that areas of townscape character can make in this situation, as potential conservation areas or as second-level local amenity designations. Its findings support the initial hypothesis: assessment of townscape quality on the basis of consistent criteria demonstrates a decline in the quality of more recent conservation area designations, and hence some devaluation of the coinage. However, the need for local discretion in the protection of local amenity supports the concept of areas of townscape and village character as an additional and distinct designation. This contradicts recent policy recommendations from the Northern Ireland Planning Commission and contains valuable lessons for conservation policy and practice in other parts of the UK.