Yes / This report presents a detailed account of a major educational initiative in the British health service, the organisation with the largest workforce in Europe. The initiative was to set up a `university for the National Health Service¿, an aspiration that gave birth to `NHSU¿. Work began in 2001, but the project ended abruptly in 2005. This paper is based on the analysis of a series of in-depth interviews with senior managerial staff and a review of policy documents. Our analysis explores both the political and the organisational aspects of NHSU. We conclude that two aspects of the initiative are key to understanding its demise: its politically-led nature and its challenge to the idea of a `university¿. Finally, we attempt to draw conclusions from the experience of NHSU to inform other state-sponsored education and training interventions.

Yes / The role of the pharmacist as we know it has altered substantially over recent years. No longer is the expectation that they are a dispenser of pills and potions and nothing else (Richardson and Pollock, 2010). Skills/competencies mapping and associated performance have been examined from a supply chain perspective e.g. Kauppi et al., 2013; Sohal, 2013; but there is limited evidence of such exploration within the pharmacy profession and healthcare operations management. The aim of this study is to explore the critical management skills needed by pharmacists to effectively perform their role within the National Health Service (UK).

Introduction: Occupational therapy in the UK has been heavily shaped by the medical model, however developments within the occupational therapy profession that have led to a re-focussing on the centrality of occupation for health have resulted in the need for new areas for practice outside of traditional, medicalised settings. The recent changing landscape of health and social care provision in the UK provides occupational therapists with new and different environments for practice. This research explored the provision of occupational therapy within social enterprises in the UK, and the compatibility of the occupational therapy philosophy with a social enterprise model. Methods: This mixed methods exploratory study that was conducted within the pragmatic paradigm and had two phases. In Phase 1, twenty-one online questionnaires were completed by occupational therapists working in social enterprises in the UK and focused on their practice and the social enterprise they work for. Social enterprises that employed occupational therapists were also identified through desk based research. In Phase 2, eight of these social enterprises (which were identified in Phase 1) participated as case studies, using case study methodology to explore occupational therapists perceptions of their practice; service users’ experiences; and the social entrepreneur’s involvement in the provision of occupational therapy. The data collection in the case studies consisted of twenty-six semi-structured interviews with occupational therapists, social entrepreneurs and service users; unstructured observation and formal documentation was used for triangulation. The interviews were analysed using qualitative thematic analysis and the findings of the case studies were combined with findings from Phase 1. Findings: Social enterprise has been used as an effective model for implementing holistic occupational therapy services that promote health, wellbeing and occupational justice. Occupational therapists benefit social enterprises to achieve their social and business aims. Funding social enterprise start-ups and ensuring their sustainability continues to be a challenge and government policy needs to be supported with finance to implement it, without which there is a risk of private companies taking over public sector services. Conclusions: Social enterprises can provide an environment where occupational therapists have freedom to practise according to the principles of their profession without the limitations of the medical model and in a socially inclusive environment. Social enterprise can provide a rewarding and satisfying environment for occupational therapists to practise in client centred, holistic ways. The current health and social care climate provides many opportunities for occupational therapists to create and shape their own environments for practise. Alternatively, occupational therapists may need to promote the profession to existing social enterprises to gain employment in the new organisations that deliver public services.

The following thesis presents an analysis of power and control in the English National Health Service. Notably, it focuses upon power and control over knowledge; over defining what is 'valid' knowledge; over the production of that valid knowledge; and over how, what, when and where that knowledge is used in everyday clinical practice. The issue reaches to the heart of professional conception and definition and hence, control over professions themselves. The thesis attempts to demonstrate the relationship between the different professional groups in the NHS, through the analysis of national, regional and local documents, and interviews with managers, doctors, nurses, dietitians and physiotherapists in three case studies, the thesis shows the complex pattern of relations and behaviour at play. Particular attention is paid to Michael Power's notion of audit and the 'Audit Explosion', which provides a framework for the thesis, and to the work of Michel Foucault, especially his ideas about power, control and panopticism. These are used as a useful metaphor to understand and explain NBS research and audit in relation to the NHS professions. The thesis ends with a cross-case analysis which draws together the rich variety of data and concludes with an analysis of the wider sociological implications ofthe thesis.

The National Health Service (NHS) is a uruque organisation which expenences continual change, making the management of the supply chain a particularly challenging area. Key relationships at the two ends of the supply pipelines between NHS buyers and their suppliers and between local NHS supplies managers and their customer base are therefore crucially important. Following the 1990 reforms and the introduction of the NHS internal market, an environment has been created in which managers are generally much more cost conscious and customer orientated. The net effect of these changes has been to raise the profile of the buyer-supplier and Supplies Manager-customer relationships. A review of the current literature has highlighted aspects of relationships that can be applied to those within the NHS supply chain as well as identifying some conceptual gaps. Initial exploratory surveys of supplies managers, NHS buyers, suppliers and end customers were undertaken with the emerging themes being further investigated through semi-structured interviews. Two relationship review tools were constructed and an action research approach adopted to evaluate the tools which involved Scottish NHS buyers with their suppliers and Scottish Supplies Managers with their end customers. The experience of the case studies suggest that the tools are a useful way of continually reviewing relationships which is necessary given the dynamic nature of the NHS. The research also suggests that purchasing relationships between NHS buyers and the suppliers currently exist along the whole of the relationship spectrum - from adversarial to partnership type - depending on the influence of particular factors. Both extremes have a place in the NHS buyer's "relationship portfolio", the challenge is to recognise when and how to adopt a particular type. The research suggests that the tool devised specifically for use by NHS Supplies Managers and their customers assists Supplies Managers in their task of identifying a means of ensuring flexible packages of care are offered to meet the increasing expectations of all customers.

This research has emanated from the geographical concerns raised by organisational change in the British National Health Service (NHS), namely the ongoing debate relating to health and health care inequalities. This thesis develops a flexible, portable and predictive model of health care utilization capable of assisting improved health care planning and analysis. In so doing it contributes to the current resurgence in medical geography. An applied approach to this research is identified which builds upon methods of modelling spatial patterns and processes in geography and the upsurge of interest in Geographical Information Systems (GIS) technology. In these terms, the use of GIS is central to the research; it supports construction and application of the model; facilitates a wide range of analyses; and provides a basis for visualisation and interpretation of model results. The value of modelling in analysing relationships between health inequalities and the location and allocation of health care is identified through a discussion of previous NHS policy initiatives and previous research. From this, a conceptual model of utilization is developed which incorporates components of need, accessibility and provision. A patient survey of asthmatics and diabetics informs the development of the model and validates the choice of indicators used to measure utilization. Indicators of need, accessibility and utilization are thus defined and subsequently measured using a signed chi-square scoring method. The model was developed and tested for primary care General Practitioner services in the Northampton District Health Authority area and outcome measures are proposed and evaluated. Rigorous testing of the model’s sensitivity and robustness is undertaken and potential for its simplification explored. Components are critically evaluated through a comparison with alternative methods of determining spatial inequalities in disadvantage. The potential of the model of utilization for health care planning and analysis is extensively demonstrated through the application of a variety of modelled scenarios. Emergent issues from the research are considered and potential for future geographical research in this area of study, and the impact upon research agendas more generally, is explored

Partnership has enjoyed fresh attention since the 1990s and consequently is a growing yet increasingly fragmented area of research. With the incoming Labour Government in 1997, policy has aimed to replace conflict with co-operation in employee relations. Partnership is an approach to managing the employment relationship based on the search for common ground between management, employees and their representatives and involves the development of long-term relationships built on high levels of trust and respect. Approaches to, and models of, partnership are still at a formative stage with no consensus on how partnership develops effectively. Despite the recognition that to understand partnership fully the study of the processes involved is necessary, little is known about these processes involved. Furthermore, the current body of literature on partnership in a UK context is limited in terms of its theoretical basis. The research set out to identify through which theoretical mechanisms partnership works. Informed by social exchange theory, the study examines the viability of partnership within the NHS and attempts to understand the conditions for its successful development. Two stages of empirical research using a mainly qualitative design were conducted. The first stage of fieldwork involved a preliminary investigation of the introduction of partnership in the National Health Service. The aim of this stage was to trace the introduction of partnership and to understand its antecedents and what had set out to achieve using data from eleven in depth interviews with key players at national, regional and local levels throughout the service. Stage two followed a case study approach and investigated the development of partnership in four NHS Acute Trusts. This stage involved a range of techniques (i.e. semi-structured interviews, focus groups, and documentation) examining the views of fifty five respondents from management and trade union representatives across the four Trusts and used data from 543 questionnaires to investigate employee's experiences of partnership. The study contributes to the partnership literature on the developmental processes of partnerships by utilising social exchange theory to better understand the viability of partnership. In particular, examining partnership from a social exchange perspective enabled a deeper understanding of the decision processes involved when deciding whether to co-operate. The study demonstrates that the theory (and its related concepts) can be helpful in examining the viability of partnership in understanding the mechanisms that lead to its successful development and the maintenance of the relationship over time. In assessing the viability of partnership, the thesis identifies the conditions under which partnership produces its effects and demonstrates how these differed in terms of changes in both the climate and the behaviour and attitudes of participants. In sum, the idea of social exchange would seem to provide an underpinning rationale for partnership. Some support for a new and expanding role for the trade union involving jOint work in developing policies was found. Trade unions appear to have a legitimate role in the relationship which is on the whole accepted by key management and trade union players. However, the union role has a low profile amongst managers and employees and trade unions lacked the organisation needed for partnership to be effective. Moreover, if trade unions are going to reap the potential rewards of partnership there should be a continuing effort to address the problems of capacity and capability (by increasing the numbers and capability of union representatives) in order to raise the profile and acceptance of the union among management and employees. In addition, there is a requirement for adequate training and support to ensure that these representatives have the attitude, skills and confidence to become effective representatives of the workforce.

CEO competence and development is a continuing concern in the NHS. As a key feature of any CEO leadership role is responsibility for organisationally critical decisions, and there is an increasing recognition of the role context plays in effective leadership behaviour. This study examines the role of contextual intelligence in relation to PCT CEO decision making behaviour. To do this, the research addresses four questions: a) what does the literature say about CEO contextual intelligence? b) what factors do PCT CEOs say they take into account in different decision making contexts? c) what contextual factors do they actually take into account? and d) what impact do the contextual factors have on their decision making behaviour. A systematic literature review resulted in a model of CEO contextual intelligence for CEO decision making. Semi-structured interviews with 24 PCT CEOs in a NHS region about factors influencing their decisions on generic strategies, national policies, regional strategies and local plans revealed a hierarchy among contextual factors applying to different decision strata. Semi-structured interviews and analysis of CEO diaries two months later of the same focal decisions show the real critical factors to be:- national policies themselves, the Strategic Health Authority and the decision making process, for regional strategies; and Top Management Team and structure for local plans. Altogether, the research reveals that the PCT CEO’s decision making context is rationally bounded; the relevant contextual factors differed significantly from the literature derived model; the actual factors in practice differed from what were espoused; choice of factors vary depending on decision trigger strata which links to degrees of CEO autonomy; and macro level factors which were indicated as significant from the systematic review were in fact ignored in practice. A PCT CEO model of contextual intelligence is developed together with a two dimensional model of underlying structures guiding PCT CEO decision making behaviour. The findings have implications for governance structures in the NHS, CEO decision making and senior leader development in ii the NHS in the context of the 2012 Health and Social Care Act. Areas for further research in public sector, NHS and contextual intelligence are also identified.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Western governments face increasing demands to achieve both cost efficiency and responsiveness in their public services leading to radical and challenging transformations. Following the imposition of New Public Management (NPM) approaches within England, it is argued that similar elements of NPM can be also seen within Scottish healthcare, despite policy divergences following devolution. This thesis considers the influence of NPM on Scottish hospital frontline nursing staff in their work. It explores the ways in which managerial practices (specifically professional management; discipline & parsimony; standard setting & performance measurement; and consumerism) have shaped the working relationships, interactions, and knowledge-exchange between managers, staff and patients and the ability of staff to carry out nursing duties within an acute hospital setting. The study is a qualitative interpretivist study grounded in the methodology of adaptive theory and draws upon the works of Lipsky (1980) in order to explore how the front-line nurses cope with and resist the demands of the workplace. Based on thirty-one qualitative interviews with front-line nursing staff in an inner city hospital in Scotland, this thesis presents the findings resulting from nurses’ views of management, finances, policies, targets, audits and consumerism. The findings show that these nurses believe there has been a proliferation of targets, audits and policies, an increasing emphasis on cost efficiency and effectiveness, a drive for professional management and a greater focus on consumerism in NHS Scotland. These are all closely linked to the ethos of NPM. From the findings it can be seen that many elements influence the working relationships of the frontline hospital nursing staff. The study suggests that the main reason for conflict between managers and nursing staff is due to their differing foci. Managers are seen to concentrate on issues of targets, audits and budgets with little thought given to the impact these decisions will have on patient care or nurses’ working conditions. Furthermore the findings highlight high levels of micro-management, self-surveillance, control and the regulation of the frontline nursing staff which has led to tensions both between nursing staff and managers, but also with patients and the public. Finally, although there has supposedly been policy divergence between Scotland and England, this thesis has identified many similarities between Scottish and English polices and NPM approaches continues to influence the working relationships of front-line nursing staff within this study despite the rhetoric that Scotland has moved away from such practices.