Middlesex University Research Repository An open access repository of Middlesex University research http://eprints.mdx.ac.uk Altabaibeh, Abdelhakim (2018) United Kingdom National Health Services: a case study of workforce transformation in an integrated care organisation using actor-network theory. PhD thesis, Middlesex University. [Thesis] Final accepted version (with author’s formatting) This version is available at: https://eprints.mdx.ac.uk/25948/ Copyright: Middlesex University Research Repository makes the University’s research available electronically. Copyright and moral rights to this work are retained by the author and/or other copyright owners unless otherwise stated. The work is supplied on the understanding that any use for commercial gain is strictly forbidden. A copy may be downloaded for personal, non-commercial, research or study without prior permission and without charge. 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See also repository copyright: re-use policy: http://eprints.mdx.ac.uk/policies.html#copy United Kingdom National Health Services: A case study of workforce transformation in an integrated care organisation using Actor-Network Theory Abdelhakim Altabaibeh BSc, MSc, RN Student number 2138543 A thesis submitted to Middlesex University in partial fulfilment of the requirements for the degree of Doctor of Philosophy School of Health and Education Middlesex University December 2017 Abstract Background: Since the 1950s the UK’s NHS went through many changes. Those changes including the most recent one; bringing care as close as possible to patients home have affected the services provided as well as those who provide them. One of the local acute health care organisations has chosen to integrate with the community and primary care services in response to this policy. A gap in literature about the role of the frontline health care professionals in the health care policy process was observed. Aim: The primary aim of this study was to examine the role that the health care professionals have in relation to health policy processes and the implications of the service integration to their professional practice. Methodology: To overcome the limitation of a single snapshot of the integration process that continues to emerge over the time, an instrumental case study approach to data collection was selected. To maintain the scope of the study, the case study approach also delineated the boundaries of what was to be studied. For the purpose of this study, two methods of data collection were utilised; in depth semi structured interviews with purposefully selected informants and documentary analyses. Actor Network Theory (ANT) was used as a theoretical framework to guide the research process. Findings: Though it could be explicit for health organisations integration as a special form of change, this study suggests that, neither the context nor the actors were the sole determinants of the outcome of the integration, it was rather the dynamic interplay between the actors, their context, the shared agency (social structures, rules, values, norms) and the resources available to them that shaped the end result. Conclusion: This thesis addresses an important issue in UK health care policy in relation to the reciprocal effect of frontline health care professionals and other policy driver on the policy implementation process and result. Acknowledgements Undertaking a PhD program was life changing for me in many ways and I thank the many people who have supported and guided me through this research experience. First of all, I gratefully acknowledge and thank my supervisors without whom I would not have made this undertaking a success. Professor Kay Caldwell’s and Dr Margaret Volante’s dedication to excellence and willingness to read through the many drafts, to provide constructive guidance, corrections, criticism and clarity of argument through the various stages of writing this thesis was invaluable. Professor Caldwell and Dr Volante Many thanks for keeping your interest up during the long journey. Many thanks for all those who helped me in this PhD scholarship and I am thankful for their contribution and support, more so to staff members of the School of Health & Education and many thanks to everybody in the postgraduate office of Middlesex University. I appreciate the assistance of the host organisation and the research participants, who made themselves available to provide me with their insights, views, and ideas. I am forever grateful to my wife Raja for her continuous support and encouragement and to my son Omar, thank you for your love, support and tolerance. Without my family’s support this thesis would have remained a dream, and it is their accomplishment as much as mine. Contents Tables, Diagrams and Figures:...........................................................................................iv Abbreviations: ....................................................................................................................v Chapter 1..............................................................................................................................1 1.1 The Research Prologue...................................................................................................1 1.2 The Impetus For This Study...........................................................................................2 1.3 Thesis Structure .............................................................................................................2 1.4 The Theoretical Orientation .........................................................................................4 1.5 Actor Network Theory ................................................................................................10 Chapter 2 ...........................................................................................................................18 2.0 Literature Review.........................................................................................................18 2.1 Introduction..................................................................................................................18 2.2 Study In Historical Policy Context...............................................................................20 2.3 The NHS Reforms........................................................................................................23 2.3.1The NHS During The 1970-1997...............................................................................23 2.3.2 The Labour Government (1997-2010)......................................................................26 2.3.3 The NHS Beyond 2010.............................................................................................31 2.3.4 The Integration Era ...................................................................................................33 2.4 The Changing Ground..................................................................................................37 2.5 Medical Professionals And The NHS...........................................................................38 2.6 Nursing And Professionalism.......................................................................................41 2.7 Nursing Jurisdiction......................................................................................................44 2.8 Changes In Practice Setting..........................................................................................46 2.9 Control of Nursing Role...............................................................................................47 2.10 Hospital As A Critical Care Provider.........................................................................48 2.11 Healthcare Reform And Nursing................................................................................50 Chapter 3 ...........................................................................................................................53 3.0 Methodology................................................................................................................53 3.1 Introduction..................................................................................................................53 3.2 Defining The Topic......................................................................................................55 3.3 The Research Questions...............................................................................................56 3.4 Research Aim and objectives.......................................................................................57