As part of the economic activity of the state, the concept of the ‘Public Plate’ is synonymous with sustainable public food procurement, where sustainable development outcomes of democracy and social justice are brought about through the provision of healthy nutritious food and localised supply chains, within a moral economy guided by an ethic of care. The economic activities of the state are also concerned with how public services are designed, delivered and accounted for, as governance. This research explores these issues through a study of the governance of nutritional care in hospital settings, the national context of Wales providing the focus for sustainable development outcomes. By examining the historical development of sustainability and healthcare governance in Wales and adopting a critical realist perspective, the research departs from the focus of existing studies on ‘what’ needs to be done, and aims to understand ‘how’ change has been brought about. The research finds that emerging structures for nutritional care in hospitals have been planned, designed and adapted over time, through leadership, learning and collaboration. Equity provides a guide for action, linking individual patients’ needs and outcomes, whilst values of dignity and respect guide activities of caring. Quality, patient experience and safety provide evidence of outcomes from those care processes as effectiveness. Effectiveness therefore becomes the driver of efficiency and efficiency drives lowest cost, resulting in best value outcomes. Variations in outcomes in practice lead to the proposition that the mechanism enabling and constraining change is that of capabilities, as an integrative concept linking structural empowerment with both cognitive and behavioural conditions. The challenges to governance are identified within best value as the need to reduce, rather than constrain costs, of particular concern in publicly funded healthcare systems where the demand for care, already in excess of supply, is expected to increase.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:585281 |
| Date | January 2013 |
| Creators | Bloomfield, Claire |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/52180/ |
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