Whose health, whose care, whose say? Some comments on public involvement in new NHS commissioning arrangements

Recent health policy in England has demanded greater involvement of patients and the public in the commissioning of health and social care services. Public involvement is seen as a means of driving up service quality, reducing health inequalities and achieving value in commissioning decisions. This paper presents a summary and analysis of the forms that public involvement in commissioning are to take, along with empirical analysis from a qualitative study of service-user involvement. It is argued that the diversity of constituencies covered by the notion of ‘public involvement’, and the breadth of aims that public involvement is expected to achieve, require careful disaggregation. Public involvement in commissioning may encompass a variety of interest groups, whose inputs may include population needs assessment, evaluation of service quality, advocacy of the interests of a particular patient group or service, or a combination of all of these. Each of these roles may be legitimate, but there are significant tensions between them. The extent to which the structures for public involvement proposed recognize these possible tensions is arguably limited. Notably, new Local Involvement Networks (LINks), which will feed into commissioning decisions, are set as the arbiters of these different interests, a demanding role which will require considerable skill, tenacity and robustness if it is to be fulfilled effectively.

Public and user participation in public service delivery: tensions in policy and practice

Social-scientific analysis of public-participation initiatives has proliferated in recent years. This review article discusses some key aspects of recent work. Firstly, it analyses some of the justifications put forward for public participation, drawing attention to differences and overlaps between rationales premised on democratic representation/representativeness and those based on more technocratic ideas about the knowledge that the public can offer. Secondly, it considers certain tensions in policy discourses on participation, focusing in particular on policy relating to the National Health Service and other British public services. Thirdly, it examines the challenges of putting a coherent vision for public participation into practice, noting the impediments that derive from the often-competing ideas about the remit of participation held by different groups of stakeholders. Finally, it analyses the gap between policy and practice, and the consequences of this for the prospects for the enactment of active citizenship through participation initiatives.

Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the ‘modernization’ of the medical workforce

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners (family physicians) with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and GPs—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest.

Liderazgo y autoeficacia en el comportamiento organizacional positivo

El objetivo que tiene este proyecto es revisar los conceptos básicos acerca de las relaciones que crean los líderes con sus colaboradores dentro de las organizaciones, dichas relaciones y vínculos pueden afectar positiva o negativamente el desempeño de sus actividades diarias dentro de una organización. Para darle inicio a la investigación se estudió como primer paso el concepto de liderazgo transformacional, capital psicológico y que componentes hacían parte de este factor. El desarrollo de la investigación se enfatizó entre el liderazgo transformacional y la autoeficacia ya que son factores claves dentro del desarrollo de las actividades organizacionales debido a que afectan claramente el capital humano de las compañías y están directamente relacionados con el crecimiento de las mismas, lo que nos llevó a preguntarnos ¿qué relación tendrá el liderazgo transformacional y la autoeficacia en la productividad de las empresas? Es aquí donde radica la importancia de esta investigación ya que el cambio de pensamiento de las organizaciones hacia un liderazgo transformacional podría lograr una maximización del desempeño del personal de trabajo en relación al objetivo de la compañía. Como conclusión llegamos a que efectivamente hay un efecto positivo en los individuos que desarrollan un capital psicológico específicamente en el factor de autoeficacia para lograr un desempeño destacable, productivo y eficiente dentro de las organizaciones.

An integrated approach for assessing the bioreceptivity of glazed tiles to phototrophic microorganisms

A laboratory-based methodology was designed to assess the bioreceptivity of glazed tiles. The experimental set-up consisted of multiple steps: manufacturing of pristine and artificially aged glazed tiles, enrichment of phototrophic microorganisms, inoculation of phototrophs on glazed tiles, incubation under optimal conditions and quantification of biomass. In addition, tile intrinsic properties were assessed to determine which material properties contributed to tile bioreceptivity. Biofilm growth and biomass were appraised by digital image analysis, colorimetry and chlorophyll a analysis. SEM, micro-Raman and micro-particle induced X-ray emission analyses were carried out to investigate the biodeteriorating potential of phototrophic microorganisms on the glazed tiles. This practical and multidisciplinary approach showed that the accelerated colonization conditions allowed different types of tile bioreceptivity to be distinguished and to be related to precise characteristics of the material. Aged tiles showed higher bioreceptivity than pristine tiles due to their higher capillarity and permeability. Moreover, biophysical deterioration caused by chasmoendolithic growth was observed on colonized tile surfaces.

Martin Lindhart (Ed.), Practicing the Faith. The Ritual Life of Pentecostal-Charismatic Christians, Berghahn Books, Oxford, 2011, 344 p.

This edited volume examines, from a ritual perspective, Pentecostal-Charismatic groups that are the fastest growing religious movements in the world today. The authors, who are anthropologists, ethnologists or sociologists (with one theologian) collected rich and diverse material on healing, deliverance, personal devotion, public engagement. Their work covers several regions such as Chile, South California, Fiji, Kenya, and Sweden. After an introduction by the editor, eleven chapters examine various issues relevant to the field. Overcoming the diversity of subjects, the unity of the volume is provided by the general ritual perspective and by the methodological implications of employing such a perspective.

Arrêt du grand conseil qui adjuge la double manse aux prieurs claustraux dans l'ordre de Cluny, payable par les prieurs titulaires sur le tiers-lot. (En faveur de P-Esbrayat, prieur claustral de Saint-Martin de la ville de Layrac.)

[Acte. 1744-02-06. Paris]

Lettres du R. P. MARTIN, cordelier, de Caen, à P.-D. Huet, évêque d'Avranches. (1697-1709).

Contient : « Remarques touchant le couvent des religieux Cordeliers de Caen, par le P. Martin, en 1698 » ; « Nobilissimæ Annæ Favier, dominæ de St -Clair, tumulus. » (En vers latins) ; Copies et extraits de lettres de P.-D. Huet au P. Martin. (Cf. le ms. français 15187) ; « Miscellanea quædam Cadomensia inedita. (1823.) D[e] L[a] Rue. » — Lettres et vers de P.-D. Huet, etc

La nationalité dans la science sociale et dans le droit contemporain / par MM. B. Akzin, M. Ancel, Mlle S. Basdevant, MM. M. Caleb, Drouillat, M. Gégout, E. Gordon, R. Kiefé, P. de La Pradelle, Martin, R. Maunier, B. Mirkine-Guetzévitch, J. Ray ; préface de MM. Lévy-Ullmann et Gidel

Collection : Série de monographies de droit public ; 3