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Overview This is a study of a key development in workforce data collection and the development of workforce intelligence in social care in England. -- Aims To investigate the establishment of the National Minimum Data Set for Social Care [NMDS-SC] in England 2003-2010. To consider the establishment of the NMDS-SC in the light of the size of and disparate numbers of employers in the social care sector, and the legal, policy and service delivery context. To consider the role of data sets in workforce planning and requirements in social care and to explore the importance of stakeholders in the development of the NMDS-SC. -- Literature The study reviews the literature about social care workforce data sets and sets it in its theoretical context. The background to the study is presented with considerations of quantitative and qualitative analyses of workforce intelligence in social care in England: the role of key organisations in data collection such as Topss/Skills for Care England, Government Departments, The Employers Organisation, the National Care Standards Commission and its successor, and the Sector Skills Council for social care, Skills for Care. -- Methods This study uses a case study approach and draws on material that is publicly available. It describes and analyses the introduction of the NMDS-SC. It uses insights from stakeholder theory, complexity theory, and the use of marketing and draws on insights from the management of change. It explores how and why the process of rationalising, systematising and modernising the process of data collection about its workforce by the English social care industry took place in the years 2003-2010.

This thesis started with the assumption that there are major defects in the Saudi referral system between GPs and specialists in hospitals. An ideal referral system was created from different resources in order to compare it with the Saudi one. In a latter stage of this research, it became apparent that these defects were only symptoms of the defects in the whole Saudi PHC system. Four different research methods were used to measure how close the ideal the Saudi referral system was, namely; questionnaires, interviewees, field observation and triangulation (city, town and village). The data gathered from GP, specialists and MOH officials indicated that the Saudi referral system is very far from ideal, (only 33.86%). There is a lot of work to be done in areas like communication between GPs and specialists, but more particularly with the nature of the PHC system including the availability of financial resources allocated to the system. Some of these problems have nothing to do with the MOH, but rather with the basic infrastructure in Saudi Arabia.

The health needs of people with learning disabilities are greater that those of the general population and yet they have inadequate access to health services. In 2001 the British government published Valuing People which demanded better access to mainstream health services for people with learning disabilities, and in England the role of health facilitation was initiated as the principle means by which the health status of people with learning disabilities throughout England was to be improved. This thesis reports on an investigation into the phenomenon of health facilitation within learning disability services in England. An eclectic methodology based on a phenomenological approach was employed to gain an understanding of the essential truths of health facilitation as experienced by health facilitators. Four research methods were utilised: a policy analysis; a Delphi study; a series of semi-structured interviews; and a reference group. Data revealed: a degree of insecurity amongst health facilitators in relation to themselves and their roles; a lack of leadership at all levels; the inadequacy of management and support available; concern as to the quality of health action plans; and the slow and limited progress achieved. The thesis notes that Valuing People (2001) had been received as a creative and innovative policy in its development and approach. However, its: vagueness towards the health facilitation role; deficiency in providing appropriate leadership; and the lack of investment in terms of health facilitator capital were found to have been detrimental to the progression of health facilitation. Valuing People (2001) predicted an annual growth of one per cent within the severely learning disabled population. This, and the damning reports relating to the failure of mainstream health services, demonstrates the relevance of this research. This thesis contributes to the body of knowledge of health facilitation and learning disability and has significant implications for health service provision, good health, and social policy.

This inquiry focused on my practice which required me to increasingly engage patients and the public in developing health and social care provision. Both retrospectively and in real time, I sought to, review and understand my own learning processes and their application into a number of successive community based projects. Through these successive projects I have observed how local knowledge can provide value to personal and collective knowing through learning to work with patients and the public at three levels, at an individual level to improve personal care, with current service users to examine and improve existing services, and with the public developing new services that are creative and innovative. This qualitative inquiry had an epistemology where the findings are specific to the particular context at particular points in time. This was important as there was no way of knowing how the participants of the projects and myself as practitioner and researcher would develop. Not one discreet event was researched, but a process of phases with different types of activities that were recorded and examined. The inquiry was underpinned by an Action Learning methodology that enabled, rather than constrained, the emergence of appropriate and varied practice methods and techniques and facilitated their integration. The theory generated from this inquiry resulted in the development of a framework for patient and public involvement. This framework provides a context for engagement at different levels of involvement through adopting critical factors for empowerment which are guided by the process and ethos of Action Learning. Consequently Action Learning is positioned as the process for facilitating transformational change in practice and practitioner development. It reinforces how appropriate the character of Action Learning can be at increasing learning at both an individual and societal level and specifically for the changing contexts of involvement, inclusion and citizenship.

Contemporary health policy places increasing emphasis on involving the public In healthcare and health research. This thesis Is an empirical Investigation of public Involvement in the National Cancer Research Network (NCRN) In England, and draws upon emergent themes in the literature relating to quality, epistemic, democratic, accountability and empowerment claims for public Involvement In research, as well as Habermas' concepts of system and lifeworld. Research alms were to explore professional and public accounts of motivations and rational isations for public Involvement In research, consider how public (lifeworld) voices may be Integrated into health research (system) spaces and, explore what counts as credible expertise In health research settings. A qualitative approach was adopted and data were collected from selected case studies (a local research panel and national Clinical Studies Groups within the NCRN). The methods included participant and nonparticipant observations, Interviews with group members (professional and public) and documentary analysis. Analysis of data revealed an inherent ambiguity In relation to public involvement In health research. Involvement served multiple purposes for the public, Including the provision of social/support functions and opportunities to reconstruct illness/caring Identities, through the development of research skills and active roles within health research. Case studies revealed Inherent tensions as the Involved public and professionals attempted to demarcate their roles and Importantly the foundations of their credibility within the group. The identification of professional and public members' attempts to prevent the Integration of the public voice casts doubt on possible empowerment claims. Furthermore, the observation that many public members were highly deferential to certified expertise calls Into question their ability to bring a different perspective to research. Ultimately, public involvement In health research may be less the potential to re-couple system and lifeworld but rather a further colonisation of the public lifeworld by professional system knowledge and expertise.

To mitigate the effects of non-recurrent congestion on the United Kingdom motorway and trunk road network, the Highways Agency (HA) has developed the Incident Support Unit (ISU) service. This research presents a review of incident management practice in the United Kingdom, in particular on the M25 London Orbital Motorway. An international comparison between British incident management operations and those in the United States is also provided. The ISU service on the M25 motorway, operated by the HA’s service provider, Carillion plc, is critically examined, including quantitative and qualitative examinations and a benefit-cost estimation. To understand fully the influence that ISUs have on the M25 road network motorway, incident data was collected and analysed. These incidents have been examined to determine their influence on traffic flow. Specifically, their impact on the capacity of the roadway and the effect of “rubbernecking” is investigated. Investigations and analysis are undertaken to evaluate the delays experienced by motorway users due to incidents. The effectiveness of motorway matrix signals and signs are then examined including compliance rates with mandatory signals and the impact of variable message signs on driver route choice. Finally, the optimal standby locations of ISUs on the M25 sphere road network are established in order to reduce their response times to incidents.

This thesis focuses on a series of publications by the author which have contributed to discussions on social and health care policy in relation to young people and parents looking after a relative or a person with disabilities in South Asian communities. The thesis reviews the research and publications that address the needs of minority ethnic disabled children and their families. The review is set within the context of literature on ethnicity, race and culture, and has three main facets: (a) to identify and summarise significant surveys, studies and related literature on informal care-giving, (b) to identify relevant literature which throws light on the circumstances which create a need for informal care, and (c) to summarise key findings relating to the provision, access and uptake of social/health care services. The thesis concludes with a discussion about the relevance of the publications to key legislation and policy with implications for practice.

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