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.

Forskning om stickrädda barn i elevhälsovården bedöms som otillräcklig, men betydelsefull då många vaccinationer sker i skolan. Syftet var att undersöka flickors upplevelser kring HPV- vaccination i elevhälsovården. Uppsatsstudien hade en mixad metod design och studien var baserad på enkätsvar från 14 flickor i årskurs fem och sex. Det kvantitativa resultatet visade att hälften av flickorna skattade sig som rädda i samband med HPV-vaccination och av dem skattade sig 42 % som livrädda. Upplevd smärta och rädslan för eventuell smärta var de faktorer flickorna uppgav skapade rädsla. Att ha en förälder och/eller en kompis med sig vid vaccinationen var enligt flickorna de viktigaste strategierna för att kunna minska deras rädsla. Det fanns en positiv korrelation mellan flickornas skattade rädsla och hur de upplevde att de inte kunde koncentrera sig på skolarbetet under hela veckan innan vaccination (r2=0,761; p=0,002). Det kvalitativa resultatet visade att flickorna upplevde starka fysiska och psykiska reaktioner såsom gråt, illamående, panik och stress, orsakade av rädsla inför, under och efter vaccinationen. Då elevhälsvårdens övergripande mål handlar om att förebygga både fysisk och psykisk ohälsa för barn och ungdomar är det viktigt att belysa problematiken med stickrädsla. Sammanfattningsvis behövs vidare forskning genomföras. Detta för att bättre kunna förstå hur omfattande stickrädsla är bland skolelever och för att sätta elevernas perspektiv i fokus. / Research on children with fear of needles in the student health service is estimated as inadequate but important because many vaccinations take place at school. The aim was to examine girls’ experiences of HPV-vaccination in student health services. The study had mixed method design and the study was based on survey responses from 14 girls in the fifth and sixth grade. The quantitative results showed that half of the girls estimated themselves as frightened during HPV-vaccination, and 42 % rated themselves as terrified. The percieved pain and fear of eventuall pain were the factors in the girls' experiences of HPV- vaccination that caused fear. Having a parent and/or a friend present as support are the two most common strategies for reducing the fear during the HPV-vaccination, according to the girls. There was a positive correlation between the girls' estimated fear and their percieved ability to not be able to concentrate on schoolwork during the week prior to vaccination (r2= 0.761; p = 0.002). The qualitative results showed that before, during and after vaccination, strong physical and psychological reactions such as crying, nausea, panic and stress were caused by fear. The student health services overall goal is about preventing both physical and mental health of children and adolescents and therefor it is important to highlight the problem of fear of needles. Further research is therefor needed to better understand the extent of fear of needles among schoolchildren and focus on their perspective.

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.

The purpose of the study was to find out how Swedbank Insurance view of health characterizes wellness work at the company. It was a qualitative study in which five persons involved in their health and wellness work were interviewed. Their business plan was based generally on the basis of the biomedical approach, but the results proved otherwise. The four categories that were set up after the results were; Health is to feel good physically as well as psychologically, health is the absence of illness, wellness is to do things together in a healthy environment and wellness is to challenge their co-workers with different kinds of challenges.

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.

The Oxford Knee Score (OKS) is a popular single summary questionnaire developed to measure the effect of knee replacement surgery from the patients' perspective. There has been a recent interest in the use of the OKS in populations of patients and in roles it has not been originally developed for. To date, no evidence has been provided about the measurement properties of the OKS when it is used outside the context or purpose for which it was originally designed. The general aim of this thesis is to investigate the measurement properties of the OKS when used in extended roles: a) within the population for which the OKS was originally intended and developed for (knee replacement) and, b) when applied on a different population, viz. patients undergoing non-operative treatment for knee osteoarthritis (OA). Four existing large-scale databases of patients undergoing knee replacement surgery and a database obtained from a prospective study on patients undergoing non-surgical management for knee OA were analyzed. The results demonstrate that: 1) it is possible to extract separate information on pain and functional disability from the OKS in a meaningful way (in the form of subscales). 2) For the first time, anchor-based Minimal Important Change (MIC) of 9 points and Minimal Important Difference (MID) of 5 points were established for joint replacement surgery. 3) The OKS demonstrated satisfactory evidence reliability, validity, responsiveness, and interpretability, when used in patients who are undergoing non-operative management for their knee OA. 4) Further evidence of validity was demonstrated by fitting the OKS to the Rasch model. 5) Lastly, it was demonstrated that thresholds can be applied on the OKS to distinguish between patients who consider their knee problem to be severe enough to warrant joint replacement surgery versus patients who do not. This supports the potential use of the OKS in decision making aids for secondary care referral. Overall the thesis provides critical evidence, not previously existing, to support the continued use, and extended use, of the OKS in orthopaedic medicine.

Spädbarnskolik är ett vanligt förekommande problem som drabbar vart femte till vart tionde spädbarn i Skandinavien och är en vanligt förekommande orsak till att föräldrar söker sig till barnhälsovården (BHV) för hjälp. Syftet med studien var att beskriva föräldrars upplevelser av att leva med ett spädbarn som har kolik. Studien utfördes som en integrativ litteraturstudie och bygger på 12 vetenskapliga artiklar. Resultatet visade att spädbarnskolik påverkade hela familjen vars vardag ständigt växlade mellan hopp och förtvivlan. Föräldrar till barn med kolik upplevde både fysisk och psykisk påverkan på hälsan. De hade svårigheter att kontrollera sina känslor vilket kunde leda till att barnet far illa. Spädbarnskolik försvårade parrelationen, påverkade relationer inom familjen och minskade föräldrarnas sociala nätverk. Avlastning från familj och vänner, samt stöd från BHV-sjuksköterska hade stor betydelse för föräldrar. Många föräldrar upplevde dock ett bristande stöd från BHV-sjuksköterskan och önskade mer bekräftelse och ökad förståelse från BHV- sjuksköterskan för vad de upplever under spädbarnets kolikperiod. / Infant colic is a common problem that affects every fifth to tenth infant in Scandinavia and is a common reason for parents seeking to child health services for help. The aim of this study was to describe parents' experiences of living with an infant who has colic. The study was conducted as an integrative literature review based on 12 scientific articles. The results showed that infant colic affected the entire family whose living constantly alternated between hope and despair. Parents of children with colic experienced both physical and psychological impact on the health. They had difficulty controlling their emotions, which could cause the child harm. Infant colic complicated partner relationships, affected relationships within the family and reduced parents' social networks. Relief from family and friends, as well as support from the CHC-nurse was of great importance to parents. Many parents, however, felt a lack of support from the CHC-nurse and wanted more confirmation and understanding from the CHC-nurse of what they experienced during the infant's period with colic.

Health is a primary objective of modern education. It was named as the first of the seven cardinal principles of education. Over a period of years the health and safety of the school children have gradually become more firmly fixed as a part of the school program. Modern schools, when adequately staffed and administered, provide experiences in healthful daily living, an opportunity to become acquainted with good health services, a chance to learn something about the care of ones own body, the maintenance of health, and the prevention of disease. Thus the schools have come to contribute to community health through their planned programs of health service and through cooperation with other health and safety agencies.