Search

Abstract The rise in chronic illness and comorbidity in Western society has resulted in an increasing emphasis on self-care initiatives. In the United Kingdom this is exemplified by the Expert Patient policy. This paper discusses the Expert Patient initiative as an example of the State’s third way approach to public health. The extent to which this policy challenges conventional power relationships between professional and patient, and fosters equal partnership is examined. In particular, how expert is defined and whether a professional understanding of the term is reconcilable with a patient’s expertise is debated. The paper argues that the Expert Patient initiative is unlikely to reconstruct chronic illness and may further complicate the State’s responsibility in meeting the needs of those with chronic illness. Issues of power within self-care are explored to illuminate the policy, and this paper argues that the Expert Patient initiative is an example of Foucault’s notion of pastoral power. Although the Expert Patient policy focuses on the rights and responsibilities of those with chronic illness, this paper concludes that there is no corresponding strategy to challenge professionals’ assumptions toward those with chronic illness. [ABSTRACT FROM AUTHOR]

The consequences of domestic abuse are far reaching, impacting significantly on long-term health and emotional wellbeing of those affected. However, while the literature offers an insight into the scope and nature of domestic abuse among the younger population in the UK, there is currently little available data regarding older women and domestic violence. This is increasingly being recognised as a significant deficit in awareness and understanding within society as a whole and more particularly for those responsible for support and care provision. While research in this area may be scarce the work that has been undertaken to date would suggest that domestic abuse is both a significant and an under-recognised phenomenon, which has a wide-ranging impact on the lives and health of older women. It also suggests that older women's experiences of domestic abuse are markedly different from those in younger age groups and that these differences have not been adequately acknowledged or accounted for. Given that the UK has an ageing population and that emerging national policy initiatives are beginning to recognise domestic abuse as an issue for older women, it is fundamental that health and social care professionals are able to both identify domestic abuse and understand the particular experiences and needs of older women affected by domestic abuse. The aim of this literature review is threefold: (i) to provide a comprehensive summary of the impact of domestic abuse for older women particularly within the context of health, (ii) to explore the particular barriers to recognition and reporting abuse and (iii) to highlight the particular gaps in our knowledge and understanding from a policy and care provision perspective. A systematic approach to a review of the literature was used to identify key literature and available evidence relating to domestic abuse among older women. [ABSTRACT FROM AUTHOR]

The confirmation of NHS responsibilities for continuing health care has important implications for primary and community health services. In early 1996, during the period of consultation on draft local policies and eligibility criteria, exploratory interviews were carried out with general practitioners (GPs), community nursing managers, primary care development officers and social services purchasers in three health authority areas. The interviews indicated that few GPs had responded to local consultation and were only slowly becoming aware of the implications for the provision and purchasing of primary and community health services. Moreover, local continuing care policies had apparently not addressed two issues which GPs and community nursing staff indicated were currently highly problematic: their responsibilities in relation to independent sector residential and nursing home patients; and the consequences for primary health and community nursing services of hospital discharge decisions. The need for purchasers and commissioners of health services, whether health authorities or GPs, to begin collecting information on patients' potential needs for continuing care services was widely recognised as an urgent priority. [ABSTRACT FROM AUTHOR]