Korman, Nancy Lincoln
(1991)
Managing change: The development of mental handicap services in South East Thames Regional Health Authority, 1978-88.
PhD thesis, London School of Economics and Political Science.
Abstract
This dissertation is an examination of the planning and management issues involved in the implementation of a regional health authority decision to close a mental handicap hospital and reprovide services in seven districts which had used the hospital. Several features made this project worthy of attention: it was among the earliest hospital closures; it involved a very large number of districts and therefore was a complex situation which nonetheless was fairly typical of long-stay hospitals in the London area; all residents, regardless of degree of disability, were to be given the chance of living in the community: local authorities were also involved along with health authorities, and this project could illustrate new principles of joint planning. The project further lent itself to a consideration of the adequacy and accuracy of the academic literature on planning and related activities. The research focussed on three areas. The first set of issues related to the approaches to planning used by regional officers who had responsibility for seeing the project through to completion. The Darenth project tested the new NHS planning system which was based on a rational planning model, and found that it could not deliver what was wanted from it. Regional officers created new types of working relationships with districts which allowed progress to be made. The second set of issues concerned the management of the rundown of the hospital. Aspects of the rundown discussed are: retention and redeployment of staff; physical contraction of the hospital; impact on residents; financing the rundown. The third set of issues related to joint planning. One of the purposes behind the introduction of joint planning into the NHS was creation of a mechanism to bring about a more appropriate balance of social and health care for people who were currently long-stay patients. But it was not joint planning with local authorities which got these residents out into the community. This study documents some of the reasons why government policy intentions could not be met. The main findings of this study point to the inadequacy of a model of planning which is based solely on rational process. Policy and implementation interact over time, as ideas and personalities change, as objectives are redefined in light of current circumstances, and as recognition is given to the competition for dominance of objectives of different participants in the planning process.
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