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This thesis is concerned with developing a sociological analysis of the history and consolidation of the medical service in English prisons. It covers the period 1774-1988 and explores a number of dimensions in relation to the Prison Medical Service (PWS) during this period. It challenges the notion of historical progression and benevolence which is often linked to an evolutionary view of medical development. An alternative theoretical perspective is proposed based on a critical reading of the work of Michel Foucault. This critical reading allows for the exploration of the relationship between medical discourse, discipline and regulation; the differential impact of medical power on women. prisoners; the relationship between "less-eligibility" and the medical care of the confined; the resistance of prisoners to medical power; the inter-relationship between professional power and the English state. From this dialectical analysis, it is proposed that wider concerns around the regulation of the body and the normalisation of the mind were crucial determining factors in the consolidation of medical and psychiatric power in English prisons.

Objective: The aims of this study were to examine urban and rural doctors' information needs and information seeking behaviours; review their use of information channels; sources; information and communication technologies and to assess their information literacy. It was expected that this would inform future efforts that support doctors in their daily care of patients. Methodology: A multi-method approach was used in this study. The main reason for that was to increase understanding gained from the quantitative data by obtaining more in-depth information from qualitative data and to integrate the advantages of both methods. Concurrent triangulation strategy was chosen to conduct the quantitative and qualitative study. An exploratory survey was the research method, and a paper based questionnaire and face to face interviews (along with critical incident techniques embedded in the interview) were the research techniques used to gather data. Results: out of 1029 questionnaires that were distributed 334 (32.46%) were returned. The valid responses were 256 (24.88%). Patient data, disease information, drug information, medical images & lab results, medical complications and guidelines were the main types of doctors' information needs. Education and clinical practice were the main contexts that give rise to doctors' information needs. Ambiguity, uncertainty, rare diseases and the multiplicity of options were the motivations for information needs. Updating, answering colleagues/patient questions and writing research papers were the purposes for which information was used. Personal library and human sources were the heavily used channels to access information. Books rather than journals was indicated the top information source. In addition, more than a quarter of urban doctors and 41.5% of rural doctors ranked online databases as the last source to be consulted. The majority of doctors indicated a difficulty in obtaining electronic information particularly from online databases; moreover the majority reported that sometimes they would like to have the search performed by a mediator. The majority demonstrated that they use field search and more than one term, but there was less use of Boolean parameters or truncation in the search strategies. Availability, ease of access and v use, integration in the work environment and information skills were the main types of barrier to using information sources, particularly electronic sources. Summary, the study identified that context, such as clinical work, where a particular task e.g. decision making leads to information needs. These may lead to information seeking behaviour to fulfil the need. However, doctors' information seeking encountered barriers that hampered the fulfilment of information needs.

Economic equality in health care continues to be a policy objective that is difficult to achieve in many countries. The aim of this thesis is to examine the effect of income level and health insurance status on the use of different health services in two contrasting funding systems, using the cases of Egypt and Lebanon. Although these countries share some similarities, they differ from one another with respect to income per capita and public financing systems. Due to these differences, it is hypothesised that the nature of economic barriers to access differs in each country. Methods used to examine the research question include descriptive and multivariate analyses of cross-sectional household survey data from the 2001 Multi-Country Survey Study, a survey conducted by the World Health Organization. Results from the analyses indicate that Egyptian respondents were more likely to use health services than their Lebanese counterparts, all other factors held equal. This result was especially evident in the case of outpatient care. Having a higher income level and health insurance were each associated with a greater likelihood of using health services, particularly for outpatient services as compared to inpatient services. These effects were also more pronounced in Lebanon. Lower-income groups tended to report worse health levels and higher out-of-pocket payments for health care as a share of income than did higher-income groups. Greater socioeconomic disparities in health were also found in Lebanon than in Egypt. This study shows that greater attention should be paid to the role of social safety nets in reducing inequalities, particularly for outpatient care.

The Chinese healthcare system incorporates two entirely different medical philosophies, namely, Traditional Chinese Medicine (TCM) and Western Medicine (WM). In the 1950s and by the request of the central government, the two medical professional communities have been both required and encouraged to collaborate with each other. In order to ensure successful implementation of the patient-centred healthcare policy also imposed by the central government, these two very different healthcare professional groups are required to communicate and share knowledge about individual patients. This tacit knowledge sharing (KS) aims at protecting the needs, interests and benefits of patients, as well as guaranteeing that the patient is at the centre of the collaborative processes. However, the two medical communities do not coexist harmoniously and do not readily communicate and share knowledge with each other. There are barriers hindering the processes of KS between TCM and WM healthcare professionals. This thesis reports a PhD research study, which aims to identify barriers to the sharing of patient knowledge between the two types of health care professionals in the context of Chinese hospitals. The study adopted a Grounded Theory approach as the overarching methodology to guide the analysis of the data collected in a single case-study design. A public hospital in central China was selected as the case-study site, at which 49 informants were interviewed by using semi-structured and evolving interview scripts. The research findings point to five categories of KS barriers: contextual influences, hospital management, philosophical divergence, Chinese healthcare education and interprofessional training. Further conceptualising the research findings, it was identified that KS is mostly prevented by philosophical and professional tensions between the two medical communities. Therefore, to improve KS and reduce the effects of the identified barriers, efforts should be made targeted at resolving both types of tensions. The conclusion advocates the establishment of national policies and hospital management strategies aimed at maintaining equality of the two medical communities and putting in place an interprofessional common ground to encourage and facilitate communication and KS. This project contributes to the general fields of knowledge management and knowledge sharing. Specifically, the study contributes to the knowledge sharing in Chinese healthcare organisations, that is, to the fields of healthcare information and knowledge management research in China.

Employing a single-site exploratory case study research methodology, this study seeks to paint a rich and detailed picture of managerial and professional perspectives of the impact of clinical governance on the professional autonomy and self-regulation of general practitioners (GPs) in a Primary Care Trust (referred to as the Utopian PCT), in the North West of England. The study defines clinical governance in the context of general practice; identifies the requirements for and barriers to its implementation; explores the role of GP Medical Advisers to the PCT and determines whether clinical governance is contributing to the deprofessionalisation (Haug 1973; 1975; 1977; 1988), proletarianisation (McKinlay and Arches 1985; McKinlay and Stoeckle 1988; McKinlay and Stoeckle 2002; Coburn 1992; Coburn et al 1997) or restratification of general practice (Fried son 1975; 1983; 1984; 1985; 1986). There are a small number of existing studies examining the impact of clinical governance on the professional autonomy and self-regulation ofGPs (SheafTet a12002; 2003; 2004; Locock et at 2004). This study focuses on the whole process of clinical governance whilst others focus on the implementation of National Service Frameworks. This is the only study employing a single-site exploratory case study methodology seeking to 'particularise' rather than to 'generalise' and to paint a rich and detailed picture of the 'human-side' of the Utopian peT and the associated general practices. Whilst never intending to be generalisable, the results of the study add to the growing body of evidence that the restratification of general practice has begun in England through GP Professional Representatives (referred to as GP Medical Advisers at Utopian PCT), employed in hybrid advisory/supervisory roles within PCTs. My study also supports Sheaff et aI's (2004) findings, suggesting that in the case of general practice, restratification does not divide the profession into separate occupational groups (Fried son 1984). Instead, knowledge management, supervision and general practice are different aspects of the same role (Sheaff et a12004; Courpasson 2000). The study demonstrates that despite the structural constraints imposed by clinical governance on general practice GPs are by no means helpless victims of government policy. Where possible they use clinical governance to their own advantage and to the advantage of their patients. They unenthusiastically implement those aspects of clinical governance they dislike but cannot avoid. The GPs participating in the study objected to what they perceived to be the managerial interference embodied in clinical governance and continued to adhere to a professional rather than a 'neo-bureaucratic' culture. The study suggests that in the future the new General Medical Services Contract (2004) will be influential in reinforcing the implementation of clinical governance in general practice.

This PhD analyses strategic health partnerships, focusing on Health Improvement Programmes (HImPs) and Health Action Zones (HAZs). It is a case study of four English health districts, based on 81 semi-structured interviews, and on partnership documents and observations. Partnership - central to New Labour's modernisation agenda for the NHS - was intended to improve the quality of health services and reduce health inequalities. This thesis conceptualises three dimensions of partnership - coordination, collaboration, participation. It uses three theoretical frameworks to interpret the nature of partnership in the study sites. Governance Theory - market, hierarchy and networks - provided a framework to conceptualise the broader context in which partnership was developed but also to explore the influence of central government on local statutory agencies. Over-use and poor co-ordination of central command and control tools strengthened hierarchical relations. Coupled with a shift towards healthcare delivery, this undermined the development of autonomous, lateral relationships. Resource Dependency Theory provided a framework to analyse the influences on horizontal relationships between local partners. This theory sees actors as selfinterested, manipulating the environment to enhance their resources while reducing their resource dependency on others. A model was developed to explain how resource motivations and symmetry combined with local circumstances to shape partnerships. Collaboration Theory provided a normative framework to assess the quality of the partnership process. According to this theory, innovative and consensual solutions to social problems emerge through inclusive processes - often involving conflict and requiring impartial facilitation. In the study sites, these processes were constrained by overbearing hierarchical relations and local influences, resulting in policy co-ordination, not radical innovation. The thesis argues that government reforms resulted mainly in partnership as coordination. Partnership as participation marginally increased while partnership as collaboration was barely evident. The shift from market to networks was undermined by the government's strengthening and (mis)management of hierarchical relations.