A challenge facing health systems such as the English National Health Service (NHS), which operate in a context of diversity of provision and scarcity of financial resources, is how organisations engaged in the provision of services can be encouraged to adopt collective resource utilisation strategies to ensure limited resources are utilised in the interests of service users and, in the case of tax funded services, the general public. In this paper the authors apply Elinor Ostrom's work concerning communities' self-governance of common pool resources to the development of collective approaches to the utilisation of resources for the provision of health services. Focusing on the establishment of Sustainability and Transformation Partnerships (STPs) in the English NHS, and drawing on interviews with senior managers in English NHS purchaser and provider organisations, we use Ostrom's work as a frame to analyse STPs, as vehicles to agree and enact shared rules governing the allocation of financial resources, and the role of the state in relation to the development of this collective governance. While there was an unwillingness to use STPs to agree collective rules for resource allocation, we found that local actors were discussing and agreeing collective approaches regarding how resources should be utilised to deliver health services in order to make best use of scarce resources. State influence on the development of collective approaches to resource allocation through the STP was viewed by some as coercive, but also provided a necessary function to ensure accountability. Our analysis suggests Ostrom's notion of resource 'appropriation' should be extended to capture the nuances of resource utilisation in complex production chains, such as those involved in the delivery of health services where the extraction of funds is not an end in itself, but where the value of resources depends on how they are utilised.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1016/j.socscimed.2020.112888 | DOI Listing |
Cancer Treat Rev
January 2025
Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address:
Importance: Endocrine treatments, such as Tamoxifen (TAM) and/or Aromatase inhibitors (AI), are the adjuvant therapy of choice for hormone-receptor positive breast cancer. These agents are associated with menopausal symptoms, adversely affecting drug compliance. Topical estrogen (TE) has been proposed for symptom management, given its' local application and presumed reduced bioavailability, however its oncological safety remains uncertain.
View Article and Find Full Text PDFEndocr Connect
January 2025
A Munir, Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland.
Omissions or delays in desmopressin can result in serious patient harm in patients with Arginine-Vasopressin Deficiency (AVP-D), formally known as Cranial Diabetes Insipidus (CDI). Desmopressin administration practice in hospitals has not been thoroughly investigated previously. This study evaluated desmopressin prescription and administration practice at a large tertiary centre.
View Article and Find Full Text PDFClin Nucl Med
January 2025
Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom.
A 57-year-old man with a 3-month history of lower abdominal pain and rectal bleeding with black stools underwent urgent abdominal CT, which revealed an ovoid hyperdense lesion in the ileum in the right iliac fossa. The prime differential was a midgut neuroendocrine tumor. Thus, the patient was referred for a 68Ga-DOTATATE PET/CT scan, which demonstrated intense activity in this lesion with no evidence of somatostatin receptor expression elsewhere.
View Article and Find Full Text PDFKidney360
January 2025
University of Manitoba, Winnipeg, MB, Canada.
Background: Cognition is a research priority for people living with chronic kidney disease (CKD), but identification of critical research questions is lacking. This study aimed to determine which cognition-related research questions are most important to CKD stakeholders.
Methods: A modified Delphi technique with 3 survey rounds was used.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!