Search

Background: Resource-use measurement is integral for assessing cost-effectiveness within trial-based economic evaluations. Methods for gathering resource-use data from participants are not well developed, with questionnaires typically produced for each trial and rarely validated. The healthcare module of a generic, modular resource-use measure, designed for collecting self-report resource-utilisation data, has recently been developed in the UK. The objective of this research is to identify and prioritise items for new, bolt-on modules, covering informal care, social care and personal expenses incurred due to health and care needs. Methods: Identification and prioritisation, conducted between April and December 2021, involved a rapid review of questionnaires included in the Database of Instruments for Resource Use Measurement and economic evaluations published from 2011 to 2021 to identify candidate items, an online survey of UK-based social care professionals to identify omitted social care items and focus groups with UK-based health economists and UK-based people who access social care services either for themselves or as carers to prioritise items. Results: The review identified 203 items. Over half of the 24 survey respondents reported no missing items. Five academic health economists and four people who access social care services participated in focus groups. Feedback shaped the social and informal care modules and indicated that no specific personal expenses were essential to collect in all trials. Aids/adaptations were highlighted as costly personal expenses when relevant; therefore, the personal expenses module was narrowed to aids/adaptations only. Conclusion: Draft informal care, social care and aids/adaptations modules were developed, ready for further testing.

Whilst researchers are increasingly required to demonstrate patient or participant involvement in the design, implementation, and dissemination of their research, very often that involvement is lacking in continuity, is defined by the researchers themselves, and is subject to the criticism of being tokenistic. This paper discusses the role played by service users in advising on a longitudinal study of the health and social care needs of a cohort of homeless women in a major city in England. It explores the experience and impact of including service user advisors within research from the perspective of the advisors themselves and researchers. Although it was a steep learning process for all concerned, the advisors became a valued part of the research team and valued the experience themselves.

A policy of separating all NHS community health services (CHS) from commissioning organisations (then primary care trusts) was launched in 2008. Some CHS were to become foundation trusts (FTs—in this case, CFTs). FTs are NHS organizations with greater autonomy from the centre, able to retain any surpluses, which are thought to be able to improve efficiency and quality of services. Those CHS not destined to become CFTs were to be merged with NHS mental health and/or hospital services, or to be ‘spun out’ of the NHS to become independent not-for-profit organisations. We observed the changes made during the preparatory period, and the expectations of the effects of FT status of the managers of CHS and their NHS commissioners, together with those CHS not on the CFT pathway. We found that all CHS in the study were becoming more business-like, and starting to improve service delivery and productivity, irrespective of whether they were destined to become CFTs. Although increased autonomy was appreciated, most CHS wanted to stay within the NHS. Some managers were concerned they would lose their autonomy when merging with other NHS services. The changes and uncertainty about organisational policy for CHS have been disruptive and time consuming.

The work of health care professionals in the United Kingdom is continually influenced by the directions, goals and principles of government and dominant groups in the policy-making process (Ackers and Abbott 1996). For too long many occupational therapists have failed to acknowledge that their work exists within a wider social context. This context controls and rations the resources that support the health and social care system and ultimately affects what occupational therapy is and the way in which occupational therapy is delivered (Øvretveit 1992). For instance, Pringle (1996) suggested that in the 1970s and 1980s occupational therapy had experienced increased autonomy and freedom to define the role and scope of its practice. As a consequence of the recent health service reforms, it is argued that this autonomy and freedom seems to have been progressively undermined. This article aims to stimulate an awareness amongst occupational therapists of the fundamental importance and relevance of an understanding of social policy to their everyday practice.