This thought-provoking book examines breakdowns in the quality of health and social care over the past decade, exploring governance failures and the challenges of achieving lasting change.

Neil Small is Professor Emeritus of Health Research at the University of Bradford, UK and is a Fellow of the Academy of Social Sciences.

Contents

Acknowledgments

Preface

Chapter One

Introduction

The presenting problem

More detail about the argument to be made (and some underlying assumptions.)

Plan of the Book.

Chapter Two: Mid Staffordshire, the Francis Report and its aftermath

Introduction.

The picture emerges.

The Francis Reports.

What had caused the "scandalous decline in standards"?

A profusion of reports - broadening the scope of concerns beyond Stafford and considering how things might change.

Culture change.

Governance - the role of individuals and of external scrutiny

The response.

The state of the NHS at the time of the Francis Report

Conclusions.

Chapter Three: The fall of the Liverpool Care Pathway and the challenges of end-of-life care.

Introduction

Criticisms of the Liverpool Care Pathway.

What problems were there in end-of-life care?

The governance of end-of-life care.

Protocols, guidelines and guidance.

Cultures of care and the challenge of change.

Progress made in implementing change in the short term

Conclusions

Chapter Four: Are problems new and are they widespread?

Introduction

Is history repeating itself? Inquiries are a form of palimpsest.

Learning disability.

Widespread problems and resistance to change.

Care of older people outside the NHS

Care of vulnerable children.

Continued failings in the care of children.

Private sector provision in childcare.

Trust, the social contract and sexual abuse

Conclusions.

Chapter Five: How the NHS and social care change and why they often don't.

Introduction

How failures come to wider attention

Routes to prevent and rectify failures from established structures and procedures: anticipatory governance.

Changing culture(s)

It's the money.

Conclusions.

Chapter Six: Conclusions.

Considering change in the NHS

Why is it difficult to ensure effective governance and to change culture?

Culture

Summary

Afterword: "good" care in (sometimes) "bad" institutions.

References