Role redesign in a modernised NHS: the case of health care assistants

This article examines role redesign in the National Health Service (NHS), which has been central to the Labour government's modernisation agenda, focusing on the role of health care assistants (HCAs). Drawing on data from two acute hospital trusts, this article focuses on variation in HCA roles between trusts, indicating that there may not have been a uniform expansion of the HCA role as the government's HR agenda and most commentators suggest. Although the modernisation agenda has curtailed registered nurses' role in direct care, there are significant variations in the degree to which HCAs undertake a ‘relief’, ‘substitute’ or ‘apprentice’ role at trust level. These variations in HCA role stem from distinctive models of the nursing workforce with differing assumptions about the respective roles of registered and non‐registered nurses. The variations in HCA role have important consequences for the prospects for role redesign and HR policy in the NHS.     

The Effects of Competition on Variation in the Quality and Cost of Medical Care

We estimate the effects of hospital competition on the level of and the variation in quality of care and hospital expenditures for elderly Medicare beneficiaries with heart attack. We compare competition's effects on more-severely ill patients, whom we assume value quality more highly, to the effects on less-severely ill, low-valuation patients. We find that low-valuation patients in competitive markets receive less intensive treatment than in uncompetitive markets, but have statistically similar health outcomes. In contrast, high-valuation patients in competitive markets receive more intensive treatment than in uncompetitive markets, and have significantly better health outcomes. Because this competition-induced increase in variation in expenditures is, on net, expenditure-decreasing and outcome-beneficial, we conclude that it is welfare-enhancing. These findings are inconsistent with conventional models of vertical differentiation, although they can be accommodated by more recent models.     

The Citizen‐Consumer as Industrial Relations Actor: New Ways of Working and the End‐user in Social Care

This article explores the role of the citizen‐consumer as an actor in public service industrial relations. Based on research into the New Types of Worker programme in social care, the article considers how new work roles engage end‐users as citizen‐consumers in work relations and their consequences for stakeholders. It highlights the forms assumed by these roles and the factors influencing their development and impact, concluding that if the citizen‐consumer is to be treated as an actor in industrial relations, researchers must show greater sensitivity to the categories of end‐users and to the service context.     

Geld En Maatschappij

Rede, uitgesproken bij de aanvaarding van het ambt van buitengewoon hoogleraar aan de Universiteit van Amsterdam op 5 februari 1962.     

Bilateral bargaining, unverifiable quality, and options to return

Summary. The paper investigates an alternating-offers bargaining game between a buyer and a seller who face several trading opportunities. These items (goods or services) differ in their non-verifiable quality characteristics which gives rise to a moral hazard problem on the seller's part. For the special case of two goods, we completely characterize the set of subgame-perfect equilibria. We find that the seller always extends an option to return the good, while the buyer may suffer from this warranty. Also, qualitatively different types of equilibrium outcomes occur depending on the parameters of the model: (a) the seller may obtain a larger share of the surplus although the parties ex ante have symmetric bargaining positions, (b) the subgame-perfect equilibrium may entail inefficient trade, and (c) multiple equilibria may exist including equilibria with delay in negotiations. Finally, we analyze a situation where bargaining proceeds after the good was returned which is shown to reestablish uniqueness and efficiency of equilibrium.Received: 23 August 2001, Revised: 3 April 2003, JEL Classification Numbers: C78, L14, L15, D82. Correspondence to: Christoph LülfesmannThis paper has greatly benefitted from discussions with Avner Shaked and Timothy von Zandt. We also wish to thank Wolfgang Leininger, Zvika Neeman, Clemens Puppe, Wolfram Richter, Karl Schlag, Ilya Segal, and seminar participants in Dortmund, Bonn and Berkeley for helpful comments and discussions. Financial support by Deutsche Forschungsgemeinschaft, SFB 303 at the University of Bonn is gratefully acknowledged.     

Flexibility and comparability in pay determination for professional civil servants

This article traces the pursuit of competing union and central Government objectives to produce a new system of pay determination for professional civil servants. It suggests that the incorporation of these objectives into this new system had a profound effect on its structure and on the way in which it has operated.