Biomedical subjects
Publications and source records attributed to T Milewa.
A telephone survey of primary care groups and trusts revealed that visits to community groups are the most favoured form of public involvement. There was some evidence of plans having been changed in response to public involvement. It is too early to say whether PCG/Ts will be more successful in involving the public in planning care than health authorities.
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Decisions by patients upon when to use health care services are a major influence on the consumption of health care resources. Patient education--often based upon written information on how to identify symptoms of common illnesses, when to seek help and how to self-treat--is an increasingly popular strategy to rationalise demand. A large body of literature, in evaluating the impact of such written information, has though overlooked the possession or acquisition of comparable publications by respondents in the course of the studies. This study attempted to overcome this limitation in considering the impact of a prominent patient education booklet that makes reference to over 40 common ailments. Questionnaire data from a cohort sample of residents (n = 495) in an area within which the booklet was circulated and that from a comparison area (n = 509) suggests that such literature exerts a modest influence in orienting patients towards "appropriate" self-referral and self-care behaviour. Reasons for this limited impact emerged however in semi-structured interviews with a sub-sample of respondents (n = 85). These data show that understanding of the way in which written advice for patients is perceived has to focus upon the ways in which diverse sub-populations process and attribute meaning to "official" and "unofficial" sources of advice. More fundamentally, the increasingly sophisticated and specialised nature of medical and scientific knowledge may be distancing expert knowledge from individuals and society such that "lay" responses to "expert" advice now reflect a continuing process of risk assessment, trust or the withholding of trust.
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The creation of a large managerial stratum within the British National Health Service in recent years has been one of the most striking characteristics of reforms intended to develop a more efficient and "business-like" service. An accompanying political rhetoric of decentralisation has cast local managerial autonomy as a means to gauge and respond more easily to the needs and preferences expressed by local communities. This article therefore reviews the growth of the new managerial stratum with particular regard to its emerging relationship with the local populations in whose name the organisational reforms have been wrought. The dominant political interpretation of this relationship--that the organisational reforms constitute a movement from leaden "bureaucratic" administration to more locally accountable and responsive managerial regimes--is then tested with regard to an in-depth study of two health authorities responsible for very different local populations. Results show that the role of local populations in influencing decisions and determining priorities is considerably less than inferred by the sustained political rhetoric in favour of the "local voices". Consideration of possible trends in the state and economy suggests however that this disjuncture may not be explicable solely in terms of the new managerial stratum maximising its influence or of central government retaining a high degree of control.
The issue of "out of hours" provision of primary care services by family doctors has excited particularly marked debate in the UK. This article considers the implications for this debate of results from a project designed to elicit the views of users of out of hours primary care provision. Focus groups were used to gauge definitions of "out of hours" services, factors governing the use of some services rather than others and influences on the evaluation of different options. The centrality accorded by patients to the social dimensions of a more "traditional" relationship with family doctors was central to the selection and evaluation of alternative provision. Any significant initiative in the reconfiguration of local health care services might thus be regarded as much a social enterprise as a technical challenge based on the most equitable and efficient application of resources.
It is often suggested that professional and managerial attitudes significantly delimit the impact of new structures for enhancing the role and influence of service users in health and social care planning. Considers the existence and clarity of such managerial attitudes in the context of one attempt to involve users in mental health care planning. The existence of latent and explicit managerial parameters to the role played by users in the planning of services was confirmed by the research at a very general level. Perhaps inevitably though, even in relation to a very specific user participation project, these parameters became less uniform as more detailed issues were considered. This suggests that an investigative focus on the "process" oriented attitudes and assumptions of managers and professionals, although important, should not be allowed to detract from a concern with gauging the demonstrable outcomes of user participation.
Explains that Health for All is an international extra-governmental movement that seeks to pursue equity in access to health-related resources by broadening the scope of health policy. Notes that its major principles include social participation in state decision making, inter-sectoral collaboration in policy formulation and the improvement of conditions for the disadvantaged. Points out that its local initiatives often encompass health-service professionals and practitioners as well as the voluntary sector, social services and other local authority departments, and that the effect of this local activity on political understandings of health at a national level gives some indication of the extent to which this local time and effort have been justified. In this respect, notes two limits to the impact of the Health for All movement on the political debates about health in Britain. Suggests that these centre on a largely indifferent but powerful national government and an emphasis within the movement initiatives at the level of a politically marginalized local state.
The urban environment represents an important social and geographical focus for the international new urban public health movement in general and the World Health Organization's 'Healthy Cities' project in particular. Existing and new policies of relevance to urban health are however infused with notions of cause, effect and ideas of appropriate intervention that reflect highly malleable and more or less conscious expressions of rationality, self-interest and organizational purpose--factors central to sociological analysis of the political discourse and objectives associated with the new urban public health movement. This article begins to develop a research agenda in this respect through consideration of the 'language' of policy and reference to Habermas' idea of 'communicative reason'. It is argued that case-study based research into the discourse of the new urban public health movement has to balance empirical accounts with analysis of the 'policy ontologies' that confront and underpin the mobilizations and has, secondly, to consider the 'communicative capacity and orientation' of such initiatives.