No / The NHS has always been a bargaining chip for politicians. Cuts to budgets; an ageing population; and more complex, comorbid long-term conditions have placed greater demands on health and care services. There continues to be pressure on GPs, community services, and the voluntary and social care sectors. Now that the political parties have presented their manifestos for the NHS, we need to consider what is right for patients and local communities.

No description available.

Over 71% of American homeless individuals are adults over 25 years of age, and the numbers are increasing. Approximately 25% of homeless individuals own a companion animal (CA). Because most service providers do not allow CAs within their facilities, the current $60.2 billion dollar national budget for homeless resources may be underutilized or forfeited altogether by homeless adults with a CA. The purpose of this study was to explore community service utilization by homeless adults with a CA through the lens of attachment theory. The research question addressed the lived experiences and perceptions of homeless adults who own CAs regarding community service utilization. This is a qualitative, hermeneutic phenomenological study in which 11 participants were interviewed individually from a semi-structured, researcher created questionnaire. Participants were homeless adults at an emergency shelter in Texas or Oklahoma where their CAs were allowed. Through coding and thematic analysis, 3 themes developed: familial attachment to a CA, a willingness to forego services that do not accommodate their CA, and false belief in their CA as a necessary service provider. The results of this study builds upon the existing body of knowledge regarding homelessness, CAs, and community services as well as informs service provision, education, and policy. Positive social change implications include awareness of the perceptions and beliefs provided by this unique unsheltered sub-population who experienced physical illnesses, trauma, and a close familial bond with their CA. Their lived experiences are key indicators for community service providers and governmental organizations consideration in reference to budgeting allocations and future research.

This study aimed to explore and develop a fresh understanding of the community service needs of persons with spinal injuries. Different concepts of need were explored, which required multiple methodologies including a review of government policies and legislation, analysis of demographic, injury related and service usage data obtained from a survey, and analysis of interviews with persons with spinal injuries and their carers. Normative need was interpreted by government and service providers in terms of functional impairment and economic disadvantage, which did not reflect the individual needs of persons with spinal injuries. Neither were services for persons with spinal injuries provided to individuals according to the criteria of their felt or expressed need for services, their perceptions of the intrinsic importance of services, nor on the basis of redressing comparative inequities in service distribution. Persons with spinal injuries’ need for community services could only be understood on the basis of the contribution services made to the realisation of their plans of life, that is, to be ordinary. In order to parallel plans of ordinariness, services need to be offered in partnership with, or under the control of the person with spinal injuries, foster an essential relationship between the provider and the person with spinal injuries, and not inappropriately assess and judge the life plans of persons with spinal injuries based upon providers’ perceptions of difference. / Doctor of Philosophy (PhD)

In Australia, the development and implementation of National Training Packages has been a major tool in the drive to reform of the vocational education and training system. The main aim of the reform is to establish a national vocational and education system within a federal political system and to make vocational educations and training providers more responsive to the needs of industry, by industry specifying its skill needs through the mechanism of national Training Packages. The background to this workplace project, the Review of the Community Services Training Package, and this study, is established by a review of policy and literature in relation to national training reform issues and stakeholder management within a public policy context. This review established some principles of good practice in relation to stakeholder management. The industry context of the workplace project is discussed. The workplace project is then unpacked in some detail with specific reference to stakeholder management strategies and issues and some specific stakeholder groups. This exegesis goes on to explore stakeholder behaviour in this particular workplace project in its historical context of the introduction of Training Packages to the vocational education and training system. It explores the perspectives of teachers and industry on the implementation of Training Packages and in particular the gap between educational technologies and industry expectations of standards of work performance. The exegesis concludes with some suggestions of opportunities for enhanced workplace practice in stakeholder management and for further research. It also suggests a job of work for industry and teachers to develop new communities of practice around Training Packages as a means of bringing together their sometimes divergent interests.

Doctor of Philosophy (PhD) / After two decades of public management reform, the ‘new accountability’ of performance measurement is a routine feature in the relationships between Australian government agencies and the non-profit organisations they fund to provide child and family services. While performance measurement offers to resolve tensions about how governments manage the quality and productivity of contracted services, the indicators they commonly adopt raise well-documented practical, political and epistemological challenges in social services. Left unresolved, these challenges risk biasing representations of service performance, by emphasising the most tangible dimensions of service activities (such as measures of client throughput) over relationship building and care. Capturing only part of service activity compromises the usefulness of performance data for managing quality and outcomes, and denies policy makers critical information about the value and meaning of care in users’ lives. This thesis identifies and critically explores one set of challenges for performance measurement: the role of service users. Uniquely, I explore how user involvement in social service evaluation can make visible how these services enhance the quality of family and personal life. Using a case study of family support services in New South Wales, the research makes a series of empirical and theoretical contributions to problems of user involvement in social service evaluation. Firstly, the research examines the performance indicators currently used by government to monitor the efficiency and effectiveness of family support services in NSW. This shows that performance indicators in family support capture output more thoroughly than outcome, and confirms the minimal role that service users play in assessing service quality and outcomes. But while service users are largely excluded from participation in performance measurement, theoretical perspectives as diverse as managerialism and feminism treat service users as well placed to capture and report otherwise elusive information about care quality and outcomes. Further, participation in evaluation facilitates the exercise of users’ rights to self-expression and self-determination in the social service delivery and policy process. After identifying the widespread exclusion of service users’ perspectives from performance measurement in NSW family support, the thesis makes its more substantial contribution, in documenting findings from a detailed study involving adult family support service users (parents) and their workers (the ‘Burnside Study’). This qualitative study was conducted in four socio-economically disadvantaged service delivery sites located around New South Wales. Using focus group, interview and observational methods and a modified grounded theory approach, the study contributes exploratory evidence of what these service users think of, and how they think about service quality, outcomes, and evaluation in family support. The parents’ accounts of using family support capture their unfulfilled social ideals and the broader visions of the justice they hoped these social services would help them achieve. Their criteria for measuring service outcomes and service quality, and their views on evaluation methods embody core themes that social theorists have struggled to analyse, about the purpose of social services and the nature of ‘a good life’. The theoretical framework I develop highlights the role of family support in the context of service users’ struggles for social justice, and in particular, their struggles for self-realisation, recognition and respect (Honneth, 1995). The research extends theories of recognition beyond publicly articulated social movements to those struggles in social life and social politics that exist in what Axel Honneth terms the ‘shadows’ of the political-public sphere (2003a: 122). After establishing a conceptual framework that facilitates deeper interpretation of users’ perspectives, I present the findings in three categories: users’ perspectives on service outcomes; users’ perspectives on service quality; and users’ perspectives on evaluation methods. The findings show how service users define ‘service outcomes’ in the context of their struggles for recognition and respect, highlighting the contribution welfare services and welfare professionals make beyond the managerial ‘Three E’s’ of economy, efficiency, and effectiveness. Further, the findings confirm the importance of ‘helping relationships’ to the quality of service delivery in family support, despite the invisibility of service relationships in existing performance indicators. The complexity of worker-client bonds highlights the difficulty of evaluating social services using simple numerical counts of client or service episodes, and plays into broader debates about strategies for revaluing care work, and the role of care recipients. Finally, the findings show the role performance measurement processes and methods might play in facilitating users’ struggles for recognition. Users identified a role for evaluation in making visible the contribution of family support in pursuing their social justice goals, and saw evaluation as an opportunity in itself to facilitate recognition and respect. Overall, the thesis offers concrete evidence about how family support service users experience and define service quality and outcomes, and how they see their own role in evaluating the services they use. The research shows how users’ perspectives both contest and confirm the ‘new accountability’ of performance measurement, pointing to new directions, and further challenges, for conceptualising – and evaluating – social services.

No description available.

Despite broader trends toward the deinstitutionalization of people with intellectual disabilities and evidence that they have a higher quality of life in the community, many in Nova Scotia remain segregated in institutional settings. In response, this thesis examines the reasons why people with intellectual disabilities are institutionalized in the province, and the barriers that exist to embracing policies of deinstitutionalization. Through participant observation, document analysis, and qualitative interview research, several themes emerged regarding the social, economic, and political factors, as well as the conflicting beliefs among implicated community members, contributing to the continued existence of institutions. Drawing on an institutional ethnography approach, this thesis examines how these factors and beliefs are related to neo-liberal philosophies and broader ideological beliefs about disability.

This research involved a rigorous implementation of the conceptual framework of Australia's National Strategy for Quality Use of Medicines through a planned sequence of studies across a large defined geographical region to test the hypothesis that: The National Strategy for Quality Use of Medicines can be used to design, implement and evaluate a research program to achieve sustained improvement in health care in a regional setting.

No description available.