ORCID Profile
0000-0002-8915-5185
Current Organisation
Kingston University
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Publisher: Hindawi Limited
Date: 11-2005
DOI: 10.1111/J.1365-2524.2005.00587.X
Abstract: Older people residents in care homes that only offer residential care rely on primary health care services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary health care team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on-site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community-based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the 171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community-based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.
Publisher: National Institute for Health and Care Research
Date: 12-2017
DOI: 10.3310/HTA21730
Abstract: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit in iduals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) ( n = 44), carers ( n = 12) and health/social care professionals ( n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling in iduals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Single-blind RCT, in idually randomised to ‘HomeHealth’ or treatment as usual (TAU). Community settings in London and Hertfordshire, UK. A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. In idual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68 p = 0.004), better grip strength (+6.48 kg p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92 p = 0.01) and increased capability-adjusted life-years [+0.017 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder ublic perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale in idually RCT is feasible. A large, definitive RCT of the HomeHealth service is warranted. This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 21, No. 73. See the NIHR Journals Library website for further project information.
Publisher: Mark Allen Group
Date: 02-03-2017
Publisher: Cambridge University Press (CUP)
Date: 13-08-2015
DOI: 10.1017/S135246581500048X
Abstract: The author list previously published for this article was incomplete when received by the journal. It should also have included Gerard Leavey, University College London, UK, as an author, as follows: Marc Serfaty, Anna Ridgewell, Vari Drennan, Chris R. Brewin, Gerard Leavey, Anwen Wright, Gloria Laycock, Martin Blanchard.
Publisher: Emerald
Date: 29-11-2013
DOI: 10.1108/WWOP-08-2013-0017
Abstract: – The purpose of this case study is to report and reflect on a recently completed five-year programme of research on dementia care and practice in England. This EVIDEM programme of research was specifically designed to influence services for people with dementia and their carers several additional lessons emerged along the way that might shape broader research on ageing that includes older people and those who work with them. – This case study of the EVIDEM programme presents and discusses four lessons learned by the core research team – covering the implications of newly basing research inside the NHS, multi-disciplinary working across academic disciplines, communicating with erse practitioners, and the impact of patient and public involvement on the research process. The paper reflects on communication between the NHS and academic communities, and the creation of new research capacity in dementia. – Collaborative working between academic disciplines is possible, given willing researchers and commitment to participating in frequent opportunities for dialogue and learning. In research in dementia these foundations are probably essential, given the growing scale of the problem and the small size of the research community, if we are to have a beneficial impact on people's lives. Lay expertise is a necessary ingredient of research programmes, not just for its co-design power, but for its ability to redesign projects when major problems arise. – This case study reports the subjective views of the research collaborators. While this raises the potential for bias, it offers an “insider” perspective of the research process and engagement in research leadership. – There are few reflections on research processes and management and this case study may be useful to academic researchers, to those working in the NHS with responsibility for research in different forms, and to older people's organisations who wish to hear of the value of older people's engagement in research advisory activity.
Publisher: Cambridge University Press (CUP)
Date: 24-11-2011
Publisher: Wiley
Date: 15-08-2010
DOI: 10.1111/J.1748-3743.2010.00231.X
Abstract: The need for healthcare practitioners to respect the dignity of older people is widely recognised in England, where it has been given attention by politicians, professionals and health service regulators. This article aims to provide ex les of how such ambitions may be used in practice development. This article reports the use of five vignettes discussed by dementia care practitioners that explored the areas of dementia diagnosis, lying, incontinence, behavioural and psychological distress, and end of life care. Each vignette promoted discussion of differences of perspectives about the ways to enhance the dignity of people with dementia in hospital, care home and community settings. The discussion confirmed that while dignity may be one quality indicator of good care potentially enhancing quality of life, it is not always straightforward. It may be more easily conceptualised when talking of physical care and treatment than other areas. The opportunity to debate the subject and to discuss practice ex les revealed differences of opinion and moral perspectives between practitioners about the use and relevance of the term dignity. These need to be acknowledged in any debates about objective and subjective definitions of quality of life.
Publisher: BMJ
Date: 02-2017
Publisher: Royal College of General Practitioners
Date: 10-2011
Publisher: SAGE Publications
Date: 11-01-2018
Abstract: Globally, populations are rapidly ageing and countries have developed health promotion and wellbeing strategies to address increasing demand for health care and old-age support. The older population is not homogeneous however, and includes a large group in transition between being active and healthy to being frail, i.e. with early frailty. This review explores the extent to which policy in England has addressed this group with a view to supporting independence and preventing further progression towards frailty. A narrative review was conducted of 157 health and social care policy documents current in 2014–2017 at three levels of the health and social care system in England. We report the policy problem analysis, the shifts over time in language from health promotion to illness prevention, the shift in target populations to mid-life and those most at risk of adverse outcomes through frailty, and changes to delivery mechanisms to incentivize attention to the frailest rather than those with early frailty. We found that older people in general were not identified as a specific population in many of these policies. While this may reflect a welcome lack of age discrimination, it could equally represent omission through ageism. Only at local level did we identify some limited attention to preventative actions with people with early frailty. The lack of policy attention to older people with early frailty is a missed opportunity to address some of the demands on health and social care services. Addressing the in idual and societal consequences of adverse experiences of those with the greatest frailty should not distract from a more distinct public health perspective which argues for a refocusing upstream to health promotion and illness prevention for those with early frailty.
Publisher: Springer Science and Business Media LLC
Date: 12-2011
Publisher: Elsevier BV
Date: 07-2004
Publisher: National Institute for Health and Care Research
Date: 08-2017
DOI: 10.3310/HTA21420
Abstract: Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. A realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders. The databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register. The scoping identified six programme theories with related context–mechanism–outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on single causes of FI such as constipation. Clinical assessment, knowledge of the causes of FI and strategies that recognise the in iduals’ preferences are necessary contextual factors. Valuing the intimate and personal care work that care home staff provide to people living with dementia and addressing the dementia-related challenges when providing continence care within the daily work routines are key to helping to reduce and manage FI in this population. The synthesis was constrained by limited evidence specific to FI and people with dementia in care homes and by the lack of dementia-specific evidence on continence aids. This realist synthesis provides a theory-driven understanding of the conditions under which improvement in care for care home residents living with dementia and FI is likely to be successful. Future multicomponent interventions need to take account of how the presence of dementia affects the behaviours and choices of those delivering and receiving continence care within a care home environment. This study is registered as PROSPERO CRD42014009902. The National Institute for Health Research Health Technology Assessment programme.
Publisher: Informa UK Limited
Date: 09-05-2011
DOI: 10.3109/13561820.2011.562332
Abstract: New models of interprofessional working are continuously being proposed to address the burgeoning health and social care needs of older people with complex and long-term health conditions. Evaluations of the effectiveness of these models tend to focus on process measures rather than outcomes for the older person. This discussion paper argues that the concept of frailty, and measures based on it, may provide a more user-centred tool for the evaluation of interprofessional services - a tool that cuts across unidisciplinary preoccupations and definitions of effectiveness. Numerous frailty scales have been developed for case identification and stratification of risk of adverse outcomes. We suggest that they may also be particularly suitable for evaluating the effectiveness of interprofessional working with community-dwelling older people. Several exemplars of frailty scales that might serve this purpose are identified, and their potential contributions and limitations are discussed. Further work is required to establish which is the most suitable scales for this application. The development of an appropriate frailty scale could provide an opportunity for interprofessional debate about the forms of care and treatment that should be prioritised to improve the health and well-being of this population.
Publisher: SAGE Publications
Date: 05-2008
Abstract: This article describes the advent of greater research funding for the study of organizations and practice in dementia care in the UK, and the development of research infrastructures. It sets out a series of challenges that locating research in service delivery organizations may raise, and addresses issues of ethics, consent, research fatigue and pressures for results.
Publisher: Hindawi Limited
Date: 16-02-2015
DOI: 10.1111/HSC.12189
Abstract: Specialist nurses are one way of providing support for family carers of people with dementia, but relatively little is known about what these roles achieve, or if they are more effective than roles that do not require a clinical qualification. The aim of this review was to synthesise the literature on the scope and effectiveness of specialist nurses, known as Admiral Nurses, and set this evidence in the context of other community-based initiatives to support family carers of people with dementia. We undertook a systematic review of the literature relating to the scope and effectiveness of Admiral Nurses and a review of reviews of interventions to support the family carers of people with dementia. To identify studies, we searched electronic databases, undertook lateral searches and contacted experts. Searches were undertaken in November 2012. Results are reported narratively with key themes relating to Admiral Nurses identified using thematic synthesis. We included 33 items relating to Admiral Nurses (10 classified as research) and 11 reviews evaluating community-based support for carers of people with dementia. There has been little work to evaluate specific interventions provided by Admiral Nurses, but three overarching thematic categories were identified: (i) relational support, (ii) co-ordinating and personalising support and (iii) challenges and threats to the provision of services by Admiral Nurses. There was an absence of clearly articulated goals and service delivery was subject to needs of the host organisation and the local area. The reviews of community-based support for carers of people with dementia included 155 studies but, in general, evidence that interventions reduced caregiver depression or burden was weak, although psychosocial and educational interventions may reduce depression in carers. Community support for carers of people with dementia, such as that provided by Admiral Nurses, is valued by family carers, but the impact of such initiatives is not clearly established.
Publisher: Springer Science and Business Media LLC
Date: 20-07-2017
Publisher: Hindawi Limited
Date: 31-05-2019
DOI: 10.1111/HSC.12781
Publisher: Cambridge University Press (CUP)
Date: 20-01-2015
DOI: 10.1017/S1352465814000514
Abstract: Backgound: Limited data suggest that crime may have a devastating impact on older people. Although identification and treatment may be beneficial, no well-designed studies have investigated the prevalence of mental disorder and the potential benefits of in idual manualized CBT in older victims of crime. Aims: To identify mental health problems in older victims of common crime, provide preliminary data on its prevalence, and conduct a feasibility randomized controlled trial (RCT) using mixed methods. Method: Older victims, identified through police teams, were screened for symptoms of anxiety, depression or post-traumatic stress disorder (PTSD) one ( n = 581) and 3 months ( n = 486) after experiencing a crime. Screen positive participants were offered diagnostic interviews. Of these, 26 participants with DSM-IV diagnoses agreed to be randomized to Treatment As Usual (TAU) or TAU plus our manualized CBT informed Victim Improvement Package (VIP). The latter provided feedback on the VIP. Results: Recruitment, assessment and intervention are feasible and acceptable. At 3 months 120/486 screened as cases, 33 had DSM-IV criteria for a psychiatric disorder 26 agreed to be randomized to a pilot trial. There were trends in favour of the VIP in all measures except PTSD at 6 months post crime. Conclusions: This feasibility RCT is the first step towards improving the lives of older victims of common crime. Without intervention, distress at 3 and 6 months after a crime remains high. However, the well-received VIP appeared promising for depressive and anxiety symptoms, but possibly not posttraumatic stress disorder.
Publisher: Wiley
Date: 26-04-2011
DOI: 10.1111/J.1365-2702.2010.03643.X
Abstract: Aim and objective. To examine the factors affecting the extent to which English policy on the introduction of community matrons for people with chronic conditions was implemented. Background. Improving health services for people with chronic diseases (long‐term conditions) is an international priority. In England, the new post of community matron, a case management role, was introduced. A target was set for 3000 community matrons to be in post by 2008, but this was not achieved. Design. A realist, pragmatic evaluation of the introduction of community matron posts. Method. The study used mixed methods at multiple levels: an analysis of national and local strategy and planning documents, a national survey and a stakeholder analysis using semi‐structured interviews in three primary care organisation case study sites. Results. National policy established targets for the introduction of community matron posts, but there was local variation in implementation. Pragmatic decisions reflected the history of local service configurations, available finance, opportunities or challenges created by other service redesigns and scepticism about the value of the community matron role. There was resistance to ‘bolt on’ nursing roles in primary care. Conclusions. The implementation of the community matron role is an ex le of how a policy imperative that valued the clinical skills and expertise of nurses was reinterpreted to fit with local patterns of service delivery. Before new nursing roles are introduced through national policies, a more nuanced understanding is required of the local factors that resist or support such changes. Relevance to clinical practice. There is a need for consultation and understanding of local conditions before the implementation of workforce initiatives. For clinicians, it is important to understand how the context of care shapes priorities and definitions of new nursing roles and how their expertise is recognised and used.
Publisher: Hindawi Limited
Date: 14-08-2012
DOI: 10.1111/J.1365-2524.2012.01067.X
Abstract: Health and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost-effectiveness for IPW, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user-defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.
Publisher: Wiley
Date: 26-10-2007
DOI: 10.1111/J.1365-2648.2007.04458.X
Abstract: This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$''social enterprise$''mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. Of 154 items included only three were empirical studies the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.
Publisher: Wiley
Date: 02-07-2010
DOI: 10.1111/J.1365-2648.2010.05377.X
Abstract: This paper is a report of a study exploring the extent and management of bladder and bowel problems in order to inform the provision and practice of prison nursing services and health care services in women's prisons. Nurses and general practitioners provide primary care services inside prisons in the United Kingdom. While high levels of mental health and addiction problems in women prisoners are recognized, there has been less focus on physical problems. Incontinence symptoms are perceived as shameful and stigmatizing, and frequently help is not sought from healthcare professionals. Guidance for assessing prisoner health does not refer to bladder and bowel symptoms. Women prisoners in a large, closed prison in the United Kingdom were surveyed in 2005 using an anonymous self-completed questionnaire. Women resident in the detoxification unit and the hospital unit, absent from their unit at the time of questionnaire distribution or deemed vulnerable by prison health staff were excluded. Questionnaires were offered to 283 women and 246 agreed to take it. Of those taken, 148 (60%) were returned. Twenty-four per cent indicated that they disclosed information about bladder and bowel problems in the survey not previously disclosed to anyone else. Forty-three per cent reported urinary symptoms. Five per cent reported nocturnal enuresis. The majority of women with symptoms reported using sanitary pads and toilet paper for containment of leakage. Prison nurses and nurse practitioners involved in reception into prison assessments should ask direct but sensitive questions about women's bladder and bowel symptoms.
Publisher: Hindawi Limited
Date: 07-05-2012
DOI: 10.1111/J.1365-2834.2012.01379.X
Abstract: To compare community matrons with other nurses carrying out case management for impact on service use and costs. In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads more patient contact time (mean 364 vs. 80 minutes per patient per month) and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. Further research on cost-effectiveness of case management models is required. The case for continued investment in community matrons remains to be proven.
Publisher: Springer Science and Business Media LLC
Date: 20-08-2011
Publisher: Springer Science and Business Media LLC
Date: 04-11-2015
Publisher: Wiley
Date: 04-2010
DOI: 10.1002/GPS.2343
Abstract: To review the evidence for end-of-life care for community dwelling older people with dementia (including those resident in care homes). An integrated review synthesised the qualitative and quantitative evidence on end-of-life care for community dwelling older people with dementia. English language studies that focused on prognostic indicators for end-of-life care, assessment, support/relief, respite and educational interventions for community dwelling older people with dementia were included. A user representative group informed decisions on the breadth of literature used. Each study selected was screened independently by two reviewers using a standardised check list. Sixty eight papers were included. Only 17% (12) exclusively concerned living and dying with dementia at home. Six studies included direct evidence from people with dementia. The studies grouped into four broad categories: Dementia care towards the end of life, palliative symptom management for people with dementia, predicting the approach of death for people with dementia and decision-making. The majority of studies were descriptive. The few studies that developed dementia specific tools to guide end of life care and outcome measures specific to improve comfort and communication, demonstrated what could be achieved, and how much more needs to be done. Research on end-of-life care for people with dementia has yet to develop interventions that address the particular challenges that dying with dementia poses. There is a need for investigation of interventions and outcome measures for providing end-of-life care in the settings where the majority of this population live and die.
Publisher: SAGE Publications
Date: 2008
DOI: 10.1258/JHSRP.2007.006057
Abstract: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and ‘modernizing’ project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. The speech can be seen as an ex le of how government has attempted to use rhetoric to make its goals attractive to nurses. Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and ‘sold’ to the nursing profession as enhancing its status compared with medicine.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Vari Drennan.