Biomedical subjects
Andrew Nocon
Publications and source records attributed to Andrew Nocon.
The role of UK general practitioners with special clinical interests: implications for policy and service delivery.
The development of specialist clinical interests by general practitioners (GPs) is currently receiving considerable attention in the United Kingdom. Although GPs have long been able to pursue such interests, it is only in recent years that they have taken on within primary care what were previously secondary care tasks, provided such services for patients outside their own practices, and received payment for them. The expansion of such services has been highlighted as a target in the NHS plan for England. Managerial and professional guidance is becoming available that seeks to clarify the role and nature of specialisation within general practice, to learn from the experiences of individuals who have embarked on specialist practice, and suggests procedures for future developments. Drawing on a range of sources, this paper builds on that burgeoning knowledge by setting the development of GPs with special interests in a broader policy context, highlighting the implications for the way that healthcare services are organised and delivered, and discussing their actual and potential impact of professional roles and practice.
A problem of communication? Diabetes care among Bangladeshi people in Bradford.
People of Bangladeshi origin in the UK continue to experience poorer health and poorer healthcare than other sections of the community. Although communication with medical and nursing staff has long been recognised as key to the provision of effective healthcare services, efforts to overcome communication problems have often been minimal: many practitioners and patients rely on informal interpreters, usually family members, to assist them, despite the shortcomings of these arrangements. The present paper examines the experiences of 12 Bangladeshi people in Bradford, obtained during the course of a wider evaluation of diabetes services. All but one of the in-depth interviews were carried out in Sylheti and explored respondents' experiences of diabetes and local services. Software-assisted analysis of the transcripts followed a framework approach. It was found that, in the absence of alternatives, informal interpreting support was a necessity for many people: making appropriate arrangements frequently involved disruption to family members' routines and responsibilities, yet access to healthcare was often not possible without them. Despite the acknowledged problems, informal arrangements were often preferred: the benefits included greater privacy, support in the consultation, and a shared understanding of advice and instructions. Many patients nonetheless received poor quality care, although this appeared to be related less to language difficulties than to professional attitudes and methods of working.
Access to diabetes services: the experiences of Bangladeshi people in Bradford, UK.
Recent years have seen a renewed emphasis in UK healthcare policy on access to services, yet there has been little research into possible inequalities in access for people from different ethnic backgrounds. This paper examines access from the point of view of a group of Bangladeshi people with diabetes, whose views were obtained as part of a wider evaluation of diabetes services. Their message is a powerful one. The problems they experienced, however, cannot be attributed solely to cultural insensitivity, in which providers adopt a 'like it or lump it' approach. The wider evaluation provides a context within which to identify similarities with, as well as differences from, other groups in the community, and the findings show that the experiences of this vulnerable group highlight more general weaknesses in service provision. The paper also shows that conventional analysis of access in terms of barriers to be overcome misses a crucial dimension: the ability to make full use of services. Gaining access does not mean that needs will be met appropriately, and patients vary in the extent to which they are able and enabled to play an active role in obtaining the services they need.
A service users' research advisory group from the perspectives of both service users and researchers.
Much has been written about the importance of involving service users in the research process. Far less is available about the experience of involvement from the perspective of service users themselves. The present paper is a joint account by service users and researchers of a service users' advisory group set up to support and advise a project to evaluate diabetes services in Bradford, UK. The establishment of a separate advisory group for service users is, to our knowledge, an innovative approach to lay involvement within mainstream National Health Service (NHS)-based research. Factors that contributed to the group's success included personal contact, continuity of membership and integration into the management structure of the project. Also valued were the confidence in numbers which membership of the group gave, and the opportunity to meet and discuss issues away from the formal and somewhat intimidating atmosphere of the project's steering group. Aside from the personal value to participants and any impact on the quality of research outcomes, wider benefits included the ability to share knowledge with others and gain greater intercultural understanding.
The housing needs of disabled people.
This paper presents the results from a study of the housing needs of disabled people in Shropshire. The study involved interviews with disabled people, representatives of a county-wide disabled people's organization, and staff from social services, housing and health agencies. A questionnaire was sent to a sample of disabled people in the county, and quantitative data were examined. The study highlighted: the high level of unmet housing need amongst disabled people, in relation to both adaptations and more appropriate housing; the need for more involvement by disabled people in the planning and provision of services; the need for greater flexibility within the housing regulations, so that services are more responsive to people's individual needs; and the inadequacy of the resources currently available to meet those needs.
User involvement and the NHS reforms.
The policy of 'user involvement' in the UK National Health Service emerged during the 1990s along with the reforms that created an internal market. Despite the official rhetoric, progress has been limited. Critics suggest that, not only was the policy flawed in its conception by the construction of service users as consumers and the conflation of consumerism with empowerment, but collaborative models of involvement have tended to legitimate rather than challenge existing provision. Some commentators have questioned the value of user involvement initiatives and proposed that alternative approaches, such as a strengthening of procedural rights or alignment with broader political campaigns, would be more appropriate. The low prominence given in the recent Government White Paper The New NHS1 to the contribution of service users, however, represents less of an ideological shift than a concentration on other, in the Government's view, more pressing priorities: namely, a concern to address the problems of public legitimacy and low staff morale by engaging in greater public participation and giving health professionals a more central role. The result has been a weakening of the users' voice by a conflation of user involvement with public participation and giving health professionals the authority to define users' needs for them. Service users risk, not only having their contribution devalued, but losing the right to an independent and distinctive voice. There is a real danger that the issues of user involvement will not be included on local agendas and the disparities between provision and need and between professionals' and users' views will increase.