‘It ain't what you do it's the way that you do it’: lessons for health care from decommissioning of older people's services

Public sector organisations are facing one of the most difficult financial periods in history and local decision‐makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes – an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health‐care. The study employed semi‐structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2‐week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision‐making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision‐making practices.     

‘Don't fix what ain't broke’: evaluating the effectiveness of a Men's Shed in inner‐regional Australia

Men's Sheds and similar community programmes are known to encourage help‐seeking behaviour and thus improve the health and well‐being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner‐regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community‐level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well‐being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed.     

The ‘price signal’ for health care is loud and clear: A cross‐sectional study of self‐reported access to health care by disadvantaged Australians

Objective: To describe self‐reported inability to access health care and factors associated with lack of access among a socioeconomically disadvantaged group. Method: A cross‐sectional survey with 906 adult clients of a large community welfare agency in New South Wales. Clients attending the service for emergency assistance completed a touchscreen survey. Results: Inability to access health care in the prior year was reported by more than one‐third of the sample (38%), compared to the 5% found for the general population. Dentists (47%), specialists (43%) or GPs (29%) were the least accessible types of health care. The main reason for inability to access health care was cost, accounting for 60% of responses. Almost half (47%) the sample reported delayed or non‐use of medicines due to cost. Increasing financial stress was associated with increased inability to access GP or specialist care, medicines and imaging. Higher anxiety scores were associated with inability to access health care, and with cost‐related inability to access medicines and imaging. Conclusion: For disadvantaged groups, cost‐related barriers to accessing care are prominent and are disproportionately high – particularly regarding dentistry, specialist and GP care. Implications: Improvements in health outcomes for disadvantaged groups are likely to require strategies to reduce cost‐related barriers to health care.