Joint Working: The Health Service Agenda

The purpose of this article is to examine the policy and practice of collaboration between health and local government from a health servicesperspective. Within this remit, the authors primarily focus on the area of primary care. Four key elements of the post-1997 policy context are discussed: the move from GP fund-holding to Primary Care Groups and Trusts (PCG/Ts); a shift from treating to preventing illness; a drive for implementation by central government; and an emphasis on collaboration. Within this broad context, there are a number of factors which may support enhanced collaboration: the size, scope, responsibilities and budgets of PCG/Ts may well provide an organisational framework which is supportive of joint working. However, the ‘Berlin Wall’ between health and social care has proved to be enduring, and there are aspects of the post-1997 policy context which will continue to inhibit effective joint working, in particular centrally designed performance management systems and the dominance by GPs of PCG/Ts.     

Touching the rainbow

Swiss‐torn painter Angelica Kauffman (1741–1807) was trained in Italy, then moved to London in 1766, where she was to stay for 15 years. Kauffman soon became one of the leading neo‐classical artists, famous for her portraits and history paintings. Her high art pictures won an enormous popularity and were executed, e.g., in interior decorations and as prints. As one of the founding members of the Royal Academy of Arts and belonging to the inner circle surrounding its president, the painter Sir Joshua Reynolds, Kauffman was commissioned for four corner roundels in the ceiling of the Council and Assembly Room in the academy's new home, Somerset House, today at Burlington House. These allegorical paintings on the appropriate theme of the Visual Arts (and part of a larger programme) are discussed in this essay, and especially one of these, representing “Painting”. By means of iconographical analysis it is argued that Kauffman, following the tradition of feminist history painters like Artemisia Gentileschi (1593–1652/53), is not only representing the theory and praxis of the artistic process but in so doing, also comments on the dominant ideology of sexual difference.     

Does the public sector outperform the nonprofit and for‐profit sectors? Evidence from a national panel study on nursing home quality and access

Are public and private organizations fundamentally different? This question has been among the most enduring inquiries in public administration. Our study explores the impact of organizational ownership on two complementary aspects of performance: service quality and access to services for impoverished clients. Derived from public management research on performance determinants and nursing home care literature, our hypotheses stipulate that public, nonprofit, and forprofit nursing homes use different approaches to balance the strategic tradeoff between two aspects of performance. Panel data on 14,423 facilities were analyzed to compare measures of quality and access across three sectors using different estimation methods. Findings indicate that ownership status is associated with critical differences in both quality and access. Public and nonprofit organizations are similar in terms of quality, and both perform significantly better than their forprofit counterparts. When compared to nonprofit and, in some cases, for‐profit facilities, public nursing homes have a significantly higher share of Medicaid recipients. The paper proposes strategies to address the identified long‐term care divide. © 2008 by the Association for Public Policy Analysis and Management.     

Study of the brainstem, particularly the arcuate nucleus, in sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD)

Complete examination of the brainstem involves transverse serial 5-microm sections made throughout the entire brainstem. The number of serial sections varies from 360 in sudden intrauterine unexplained death (SIUD) to 600 in term fetuses to over 1400 sections in sudden infant death syndrome (SIDS) victims. The procedure is not applicable in all histopathological laboratories, owing to the need for additional technical personnel. The simplified procedure allows a remarkable reduction of the number of sections. The brainstem is divided into 3 blocks. The first, cranial block, extends from the border between the medulla oblongata and pons up to the upper pole of the olivary nucleus. The second, intermediate block, corresponding to the submedian area of the inferior olivary nucleus, has as reference point the obex and extends 2 to 3 mm above and below the obex itself. The third, caudal block, includes the lower pole of the inferior olivary nucleus and the lower adjacent area of the medulla oblongata. Examinations of the brainstems from 106 SIDS victims, 30 controls, and 51 stillborns underlined a remarkable variability, particularly of the arcuate nucleus. The simplified examination of the brainstem makes it possible to evaluate the structures, examining 3 specific levels, defined by morphologic reference points.