How do social health care policies fare within economically rational structures? This paper, based on a study of two Scottish maternity units, identifies and explains a number of gaps in social health care policy implementation and practice. One finding suggests that devolved budgets result in a certain amount of operational fragmentation, increased attention to cost consciousness, low staffing levels and ultimately a noticeably decreased concern for social health care policy implementation. What can be done to ensure that health and welfare services are democratized? This paper proposes that moving beyond new public management involves an alternative model which would encompass a broadened form of economic regulation. Such a model would ensure that health and welfare outcomes are comprehensively accounted for in financial terms. There are strong indications that subjective service user indicators of health and welfare are just as important as objective professional assessments. Another indication is that whereas technological determinism sparks off rising costs, service user self-determination and self-management, which situates medical expertise at the periphery rather than the centre, could save public money. Thus, the need to widen the economic base serves both the objectives of the treasury and the needs of the public.
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References
1.
Amos, A., Jones, L. and Martin, C. (1988), 'Maternity Services in Lothian: A Report of a Survey of Users' Opinions', (University of Edinburgh).
2.
Barkley, K. and Barkley, L. (1998), 'Increasing the Value: Health, Economics and Qualitative Methods', Social Sciences in Health, Vol 4, No 1, pp. 15-24.
3.
Blum (1984), quoted in Buchanan, D., Boddy, D., McCalman, in Bryman, A. (1988), 'Getting in, getting on, getting out, and getting back', in Bryman, A., Doing research in Organisations, (London: Routledge).
4.
Broadbent, J. and Laughlin, R. (2002), 'Public Service Professions and the New Public Management. Control of the professions in the public services', in Mclauglin, K., Osborne, S.P. and Ferlie, E. (2002), New Public Management Current trends and Future Prospects, (London: Routledge).
5.
Buchanan, D., Boddy, D. and McCalman ( 1988), in Bryman, A., 'Getting in, getting on, getting out, and getting back', in Bryman, A., Doing research in Organisations, (London: Routledge).
6.
Clarke, J. and Newman, J. (1997), The managerial state: power, politics and ideology in the remaking of social welfare, (London: Sage).
7.
Department of Health (1993), Changing Childbirth: Parts 1 and 2 Report of the Expert Maternity Group (Cumberledge Report) (London: HMSO).
8.
Eddy, J.W. (2000), 'Is childbirth safe in the UK and are there enough obstetricians?' Hospital Medicine, Vol 61, No 3, March.
9.
Ferlie, E., Ashburner, L., Fitzgrald, L. and Pettigrew, A. (1996), The New Public Management in Action, ( Oxford: Oxford University Press).
10.
Ferlie, E. and Mack, A. (2002), 'Organisational research and the New Public management. The turn to Qualitative Methods', in Mclaughlin, K., Osborne, S.P. and Flint, C. (1991), ' Labour: the importance for a woman to be in control of her own childbearing ', Journal of Obstetrics and Gynaecology, Vol 11, No 1, pp.20-22.
11.
Flint, C. (1991), 'Labour: the importance for a woman to be in control of her own childbearing', Journal of Obstetrics and Gynaecology , Vol 11, No 1, pp.20-22.
12.
Flint, C., Poulgeneris, P. and Grant, A. (1989), 'The "Know Your Midwife" scheme - a randomised trial of continuity of care by a team of midwives', Midwifery , Vol 5, pp. 11- 16.
13.
Garcia, J. (1998), First Class Delivery: A National Survey of Women's Views of Maternity Care, (Audit Commission).
14.
George, V. and Miller, S. (1994), Social Policy Towards 2000: Squaring the Welfare Circle, (Routledge).
15.
Glaser, B.G. and Strauss, A.L. (1967), The Discovery of Grounded Theory, ( New York: Aldine).
16.
Glazener, C.M.A. et al. (1995), 'Postnatal maternity morbidity: extent causes prevention and treatment', British Journal of Obstetrics and Gynaecology, Vol 102, pp.282-287.
17.
Gorz, A., (1989), Critique of Economic Reason, trans. G. Handyside and C Turner, (London: Verso).
18.
Gready, M., Newburn, M., Dodds, R. and Gauge, S. (1995), Birth Choices: Women's expectations and experiences , (London: National Childbirth Trust ).
19.
Guest, D. and Conway, N. (2002), Pressure at Work and the Psychological Contract , (London: CIPD).
20.
Hodnett, E.D. (2001), 'Caregiver support for women during childbirth (Cochrane Review)', in The Cochrane library, 2, (Oxford: Update Software).
21.
Hood, C.A. (1991), 'Public Management for all Seasons?', Public Administration, Vol 69 (Spring), pp.3-19.
22.
Hood, C. (1995), 'The New Public Management the 1980s: variations on a theme', Accounting, Organizations and Society, Vol 20, No 2/3, pp.93-109.
23.
James, A. (1994), Managing to Care: Public Service and the Market , (Longman Group Ltd).
24.
Jones, P. (1990), 'Implications for Practice', in Faulkner, A. and Murphy-Black, T. (ed.), Excellence in Nursing - the research route, (London: Scutari Press).
25.
Kenny R., Brodie P., Eckerman S. and Hall J., (1994), 'Westmead Hospital Team Midwifery Project', quoted in NHMRC (1996), Options for Effective Care in Childbirth, (Commonwealth of Australia).
26.
Kirkpatrick, I., Ackroyd, S. and Walker, R. ( 2005), The new managerialism and public service professions: change in health, social services and housing, (Basingstoke : Palgrave).
27.
Lincoln, M.G. (2004), 'Changing Childbirth and Maternity Services in Scotland', Aims Journal, Vol 16, No 1, pp. 18-20.
28.
MacArthur, C., Lewis, M. and Knox, E.G. (1991), Health after Childbirth, ( London: HMSO).
29.
Mclaughlin, K., Osborne, S.P. and Ferlie, E. (2002), New Public Management Current trends and Future Prospects, (London: Routledge).
30.
Mannion, R. and Small, N. (1999), 'Postmodern Health Economics', Health Care Analysis, Vol 7, pp.255-272.
31.
Miles, M.B. (1979), 'Qualitative Data is an Attractive Nuisance. The Problem of Analysis', Administrative Science Quarterly, Vol 24, No 4, pp.590-601.
32.
Mugford, M. (1990), 'Eonomies of scale and low risk maternity care: what is the evidence?', Maternity Action, London, Sep/Oct, No 46, pp.6-8.
Oakley, A. (1989), 'Who cares for women? Science versus love in Midwifery Today', Midwives Chronicle and Nursing Notes, July, 214-221.
35.
Oakley, A., Hitchet, D. and Rajan, A.S. (1996), 'Social support in pregnancy: does it have long-term effects?', Journal of Reproductive and Infant Psychology, Vol 14, No 1, pp.7-22.
36.
Polanyi, K. (1957), The Great Transformation, ( Boston, Mass.).
37.
Pollitt, C. (1986), 'Beyond the Managerial Model: The case for broadening performance assessment in Governement and the Public Services', Financial Accounting and Management, Vol 2, No 3, 99, pp.155-70.
38.
Pollitt, C. (1993), Managerialism and the public services, (Blackwell Publishers Ltd).
39.
Pope, C. and Mays, N. (1995), 'Reaching the Parts Other Methods Cannot Reach: An Introduction to Qualitative Research and HSR', British Medical Journal, 311, pp.109-112.
40.
Power, M. and Laughlin, R. (1992), 'Critical Theory and Accounting', in Alveson, M., Willmott, H. (eds), Critical Management Studies, ( London: Sage).
41.
Pusey, M. (1991), Economic Rationalism in Canberra, ( Cambridge: Cambridge University Press).
42.
Raadscheldon, J.C.N. and Toonen, T.A.J. (1999), 'Public Sector Reforms for Building and Recasting the Welfare State Experiences in Western Europe', Research in Public Administration, Vol 5 (199), pp.39-62.
43.
Rooks, J. and Haas, J. (1992), Nurse Midwifery in America. A Report of the American College of Nurse-Midwives, (Washington DC: American College of Nurse-Midwives Foundation), pp.32-35.
44.
Rosenblatt, R. (1987), 'Perinatal Outcome and family medicine - Refocusing the Research Agenda', Journal of Family Practitioners, Vol 24, pp.119-22.
45.
Rosser, J. (2001), 'Birth centres across the UK: A win/win strategy for saving normal birth', RCM Midwives Journal, March, Vol 4, No 3, pp.88-89.
46.
Rowley, M. (1993), 'A Randomised Controlled Trial of Continuity of Midwifery Care'. Presentation at the 11th Annual Congress of Australasian Perinatal Society, July 20-23.
47.
Ryan, M. and Shackley, P. (1995), 'Assessing the benefits of health care: how far should we go?', Quality of Health Care, Vol 4, pp.207-13.
48.
Saunders, D., Boulton, M., Chapple, J., Ratcliffe, J. and Levitan, J. (2000), Evaluation of the Edgware Birth Centre, (Middlesex: North Thames Perinatal Public Health).
49.
Scottish Executive (1998), Health in Scotland, (SEHD Edinburgh: The Stationery Office).
50.
Stewart, J. and Ranson, S. (1988), 'Management in the Public Domain', Public Money and Management, Vol 8, Nos 1 and 2, pp. 13-19.
51.
Stewart, J. and Walsh, K. (1992), 'Change in Management of Public Services', Public Administration, Vol 70, No 4, pp.499-518.
52.
Tew, M. and Damstra-Wijmenga, S.M.I. (1991), 'Safest Birth attendants: recent Dutch evidence ', Midwifery, Vol 7, pp.55-63.
53.
Titmuss, R. (1958), Essays on the Welfare State, ( Unwin University Press).
54.
Toynbee, P. (1999), 'Shellshocked by cost of complaints', BMA News Review, 17 July, p.29.
55.
Walsh, D. (2000), 'Evidenced-based care series 2: Free standing birth centres', British Journal of Midwifery, Vol 86, No 6, pp.351-355.
56.
Walsh, K. (1995), Public Services and Market Mechanisms: Competition, Contracting and the New Public Management, (Macmillan).
57.
Walsh, D. and Newburn, M. (2002), 'Towards a social model of childbirth British ', Journal of Midwifery, Vol 10, No 8, pp.476-481.
58.
Young, G.L. (1994), 'Place of Birth', in Chamberlain, G. and Patel, N. (eds), The Future of Maternity Services, (London : RCOG Press).
