ABSTRACT: The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to ...
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Public mental health has long struggled to be accepted as a part of health care. Its interface with social services and its broad spectrum of professionals make a clear definition of public mental health's boundar...
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Public mental health has long struggled to be accepted as a part of health care. Its interface with social services and its broad spectrum of professionals make a clear definition of public mental health's boundaries difficult, fueling policymakers' skepticism about such acceptance. The Oregon Health Plan was the result of a process that explicitly included mental health but recognized that the tools for doing so need to be carefully developed.
Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, ‘in few areas can the gap between political rh...
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Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, ‘in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great’. This paper examines the extent and causes of this ‘implementation gap’ in respect of services for people with mental handicaps—a consistent priority group for national policymakers. We examine centre–periphery relations in the health and personal social services in the light of Rhodes' power–dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve.
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