Sub-Optimality in NHS Sourcing in the UK: Demand-Side Constraints on Supply-Side Improvement

The UK NHS and its Purchasing and Supply Agency (PASA) are implementing reforms for the procurement of goods and services. One aspect of the new approach creates regional confederations in order to overcome the current inability to enforce 'National Framework Agreements' within individual NHS Trusts. This is a sensible approach to resolving a lack of effective consolidation of demand within the NHS at the Trust level, but recent research into the procurement practices of regionally based NHS Trusts has highlighted a number of internal demand problems that this new approach is unlikely to overcome. These include the failure by the Trusts individually, and by the NHS centrally, to control and manage the NHS design and specification process effectively and, in many cases, an inability to measure or collect information on the clinical and cost effectiveness of medical interventions. It is argued, therefore, that while the new reforms may be an improvement on the past, it is likely that the confederations are destined to fail. This is largely the result of the NHS – centrally, regionally and locally – lacking an understanding of how to align demand and supply effectively so as to provide the levers to manage the procurement of goods and services proactively.     

More of the Same? A Dual Case Study Approach to Examining Change Momentum in the Public Sector

Despite the significant amount of change experienced by the public sector, there has been relatively limited empirical examination of how change agendas affect public sector employees in Australia. This article presents a comparative analysis of two Australian public sector organisations that implemented the same positive work change agenda, but experienced very different outcomes. Using a critical realist approach, we draw on a mix of qualitative techniques to suggest that textbook notions of ‘successful change’, which are often derived from large private sector expectations, may fail to capture the complex nature of how public sector change initiatives may unfold. In particular, we demonstrate how political, temporal, contextual, and process factors interact to shift change momentum. Illustrative examples are provided throughout and the findings are discussed in terms of their implications for theory building, for change facilitation, and for future research.     

Acculturation Strategies and Mental Health in Gay,Lesbian, and Bisexual Youth

In this article, we examine the impact of acculturation strategies on minority stress and mental health in lesbian, gay, or bisexual (LGB) youth in Flanders, Belgium. Building on previous identity minority studies and on the social stress model, we investigate how LGB youth acculturate within both the LGB subculture and mainstream society and how this correlates with their mental health. Our sample is taken from an online survey and represents 561 LGB youth aged 14 through 21. The four traditional acculturation strategies are represented in this population (integration, separation, marginalization, assimilation). Bisexual boys are mostly absent from separation and integration strategies; gay and lesbian youth in middle adolescence are significantly more represented in the separation strategy compared to their late adolescence counterparts. Further, our findings suggest the relevance of identification with the LGB community, especially for internalized negative attitudes toward homosexuality. LGB youth who identify with the LGB community score significantly lower on this internalized homonegativity.