Mark Exworthy
Biographic Data
| ID | 247488 |
|---|---|
| NAME | Mark Exworthy |
| GIVEN NAMES | Mark |
| FAMILY NAME | Exworthy |
| SIGNATURE | EXWORTHY M |
| AFFILIATIONS | Royal Holloway University of London |
| ORCID | 0000-0003-4791-7513 |
| VERIFIED | Yes |
| TOTAL WORKS | 36 |
| TOTAL CITATIONS | 297 |
| AUTHOR COUNT | 36 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1994 |
| LATEST PUBLICATION YEAR | 2024 |
| H-INDEX | 10 |
Children’s hospitals in the British NHS
Patient mobility is a complex phenomenon, involving both outward and inward flows, and treatments that are more and less complex and where choice may be driven by quality and availability rather than solely cost. Public health systems in high-income and middle-income countries are facing increasing financial pressures given population ageing, a rapid rise in chronic and non-communicable diseases and fiscal restraint. In this context, the intersec…
The policy and politics of healthcare corporatisation
On the character of the new entrepreneurial National Health Service in England
Recent health care reforms in England, combined with financial austerity, have accelerated both corporatization and commercialization in the English National Health Service (NHS) and this has encouraged greater public sector entrepreneurialism (PSE). We advance this argument by examining the meaning and experience of corporatization in this sector, illustrating our argument with qualitative data from a specialist hospital at the forefront of this…
Professional autonomy and surveillance
Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form …
Partnerships, quasi-networks and social policy
Bridging the discursive gap between lay and medical discourse in care coordination
For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients' oral narratives and medical sense-making; and whether a modified form of 'narrative medicine' might mitigate them. We systematically compared 66 general practice patients' own narratives of their health problems and care with the cont…
Knights and Knaves in the English Medical Profession
We elaborate Le Grand's thesis of 'knights and knaves' in terms of clinical excellence awards (CEAs), the 'financial bonuses' which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are 'individuals who are motivated to help others for no private reward' while knaves are 'self-interested individuals who are motivated to h…
The Iron Cage and the Gaze
This paper seeks to determine the value of theoretical ideal-types of medical control. Whilst ideal types (such as the iron cage and gaze) need revision in their application to medical settings, they remain useful in describing and explaining patterns of control and autonomy in the medical profession. The apparent transition from the cage to the gaze has often been over-stated since both types are found in many contemporary health reforms. Indeed…
Framing in policy processes
International patients within the NHS
Market size, market share and market strategy
The aim of this article is to contribute towards greater theoretical and empirical understanding about medical tourism developments globally. This evidence leads us to examine some widelyheld assumptions regarding the size and shape of global medical travel. Our paper examines three central issues: (1) Do published figures and projections ‘add-up’, are figures from multiple sources consistent, and what decisions and interests are involved for tho…
A Framework for Exploring the Policy Implications of UK Medical Tourism and International Patient Flows
It is estimated that over 50,000 individuals from the UK each year elect to fund their own treatment abroad. Such treatments commonly include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The UK has also experienced inward flows of patients who travel to receive treatment and pay out of pocket, being treated in both private and NHS facilities. The rise of ‘medical tour…
Has the British National Health Service (NHS) got talent? A process evaluation of the NHS talent management strategy
In 2004, the British National Health Service (NHS), an organisation with one of the largest workforces in the world, adopted a new approach to identifying and developing managers, which was refreshed in 2009 with ‘guidance for NHS talent and leadership plans'. This paper explores the introduction of talent management (TM) in the British NHS, focusing on process evaluation. It discusses the introduction of TM in the NHS before examining the stated…
Making Health Policy
Alaszewski, A. and Brown, P. Making Health Policy: A Critical Introduction . Cambridge : Polity , 2011 , £16.99 (pbk) ix+ 292 pp : ISBN : 978-0-7456-4174-4 At a time when the Health and Social Care Bill is being implemented across England, it is arguably more important than ever to understand and explain the content, process and impact in health policy. Whilst description of such reforms abound, careful and detailed analysis is sadly often lackin…
Towards a Sociology of Disclosure
Despite the increasingly widespread emphasis on the need for transparency in health‐care and elsewhere, there is limited evidence regarding the consequences of disclosing medical performance data. The evidence is disparate and has not been synthesised in a coherent way. This paper focuses on surgical performance, whose measurement is generally often seen as straight forward. It begins by outlining the context for understanding the publication of …
Shaping Health PolicyCase Study Methods and Analysis
This book examines the role that case studies play in understanding and explaining British health policy. Overall, the chapters cover the key health policy literatures in terms of the policy process, analytical frameworks and some of the seminal moments of the NHS. They have been written by health policy researchers in sociology, social policy, management and organisation studies. The book explores and promotes the case study as an under-used met…
Shaping Health Policy
The Challenge of Joined-Up Government in Tackling Health Inequalities
Joined-up government (JUG) has been a notable feature of many national governments, not least the UK Labour government (1997 onwards) with its emphasis on welfare modernisation, tackling engrained social problems, and evidence-based policy. This article focuses on the ways in which JUG has been implemented in England although we draw comparisons with the different approaches in Wales and Scotland, as devolution has provided an interesting natural…
The illness narratives of health managers
This paper examines the personal experience of illness and healthcare by health managers through their illness narratives. By synthesising a wider literature of illness narratives and health management, an analytical framework is presented, which considers the impact of illness narratives, comprising the logic of illness narratives, the actors involved and strategies, including the contexts in which those illness narratives are used and the impac…
Policy Entrepreneurship in the Development of Public Sector Strategy
The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter‐related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entr…
Plus ça change, plus c'est la même chose
The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, director…
Has Labour decentralised the NHS? Terminological obfuscation and analytical confusion
This article considers the rise of decentralisation as an approach to public-sector \nreform generally, and its approach to the British National Health Service (NHS) \nspecifically. It suggests that the term ‘decentralisation’ is often so poorly defined \nthat reforms made in its name cannot be assessed to see if they have achieved it as \na goal or not. The article explores the meanings of decentralisation and attempts \nto clarify it, before go…
Room for manoeuvre?
Policy to tackle the social determinants of health
Like health equity, the social determinants of health (SDH) are becoming a key focus for policy-makers in many low and middle income countries. Yet despite accumulating evidence on the causes and manifestations of SDH, there is relatively little understanding about how public policy can address such complex and intractable issues. This paper aims to raise awareness of the ways in which the policy processes addressing SDH may be better described, …
Decentralizing Health Services in the Uk
Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are …
Big Windows and Little Windows
This paper argues for the need to re‐assess models of policy implementation in the ‘congested state’. This re‐appraisal focuses on two main directions. The first involves locating implementation in the context of wider models of the policy process. We fuse three models, those of Kingdon, Wolman, and Challis et al ., to form a new ‘policy streams’ approach. The second examines implementation in multi‐level governance. In the UK and elsewhere, much…
How great expectations in Westminster may be dashed locally
English Tackling health inequalities is a policy priority for the Labour government in the UK. We use Kingdon’s model of ‘policy streams’ to explain how the issue of health inequalities gets onto the policy agenda nationally and locally, and how it is being implemented. Using empirical evidence from local agencies, we suggest that the issue of health inequalities is on the agenda nationally and locally but implementation is hampered by deficienci…
Policy Entrepreneurship in the Development of Public Sector Strategy
The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter‐related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entr…
Market size, market share and market strategy
The aim of this article is to contribute towards greater theoretical and empirical understanding about medical tourism developments globally. This evidence leads us to examine some widelyheld assumptions regarding the size and shape of global medical travel. Our paper examines three central issues: (1) Do published figures and projections ‘add-up’, are figures from multiple sources consistent, and what decisions and interests are involved for tho…
Policy to tackle the social determinants of health
Like health equity, the social determinants of health (SDH) are becoming a key focus for policy-makers in many low and middle income countries. Yet despite accumulating evidence on the causes and manifestations of SDH, there is relatively little understanding about how public policy can address such complex and intractable issues. This paper aims to raise awareness of the ways in which the policy processes addressing SDH may be better described, …
The role of performance indicators in changing the autonomy of the general practice profession in the UK
International patients within the NHS
Geographies of Care
Framing in policy processes
Access, Choice and Travel
The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be th…
Plus ça change, plus c'est la même chose
The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, director…
Decentralizing Health Services in the Uk
Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are …
On the character of the new entrepreneurial National Health Service in England
Recent health care reforms in England, combined with financial austerity, have accelerated both corporatization and commercialization in the English National Health Service (NHS) and this has encouraged greater public sector entrepreneurialism (PSE). We advance this argument by examining the meaning and experience of corporatization in this sector, illustrating our argument with qualitative data from a specialist hospital at the forefront of this…
Clinical Audit in the NHS internal market
Relations between managers and professionals in the public sector have often centred on the control of work performance. Work performance strategies and techniques have been transformed by recent public sector policies involving managerialisation and quasi-markets. In particular, the clinical audit programme in the National Health Service has traditionally been the preserve of professionals, mainly doctors but managers and purchasers have become …
The Contest for Control in Community Health Services
General Managers (GMs) represent a relatively new cadre in the British National Health Service (NHS) who have become closely aligned with central government policy in recent years. GMs have increasingly been appointed to local levels in the NHS which could potentially lead to a clash with other professional domains. This paper uses the example of a decentralisation policy to trace the contest between GMs and professionals during its implementatio…
Bridging the discursive gap between lay and medical discourse in care coordination
For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients' oral narratives and medical sense-making; and whether a modified form of 'narrative medicine' might mitigate them. We systematically compared 66 general practice patients' own narratives of their health problems and care with the cont…
Professional autonomy and surveillance
Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form …
Making Health Policy
Alaszewski, A. and Brown, P. Making Health Policy: A Critical Introduction . Cambridge : Polity , 2011 , £16.99 (pbk) ix+ 292 pp : ISBN : 978-0-7456-4174-4 At a time when the Health and Social Care Bill is being implemented across England, it is arguably more important than ever to understand and explain the content, process and impact in health policy. Whilst description of such reforms abound, careful and detailed analysis is sadly often lackin…
Equal Access to Health Care and the British National Health Service
Equal access to health care is a central objective of many health care systems, and is often seen as the founding principle of the British National Health Service. However, this paper argues that it can be seen as a piece of grand or flamboyant rhetoric of symbolic politics, representing a misreading, or at least an oversimplification, of history. It examines stated equity objectives in the NHS by placing them in the cells of an equity matrix. It…
Knights and Knaves in the English Medical Profession
We elaborate Le Grand's thesis of 'knights and knaves' in terms of clinical excellence awards (CEAs), the 'financial bonuses' which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are 'individuals who are motivated to help others for no private reward' while knaves are 'self-interested individuals who are motivated to h…
A Framework for Exploring the Policy Implications of UK Medical Tourism and International Patient Flows
It is estimated that over 50,000 individuals from the UK each year elect to fund their own treatment abroad. Such treatments commonly include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The UK has also experienced inward flows of patients who travel to receive treatment and pay out of pocket, being treated in both private and NHS facilities. The rise of ‘medical tour…
Towards a Sociology of Disclosure
Despite the increasingly widespread emphasis on the need for transparency in health‐care and elsewhere, there is limited evidence regarding the consequences of disclosing medical performance data. The evidence is disparate and has not been synthesised in a coherent way. This paper focuses on surgical performance, whose measurement is generally often seen as straight forward. It begins by outlining the context for understanding the publication of …
Has Labour decentralised the NHS? Terminological obfuscation and analytical confusion
This article considers the rise of decentralisation as an approach to public-sector \nreform generally, and its approach to the British National Health Service (NHS) \nspecifically. It suggests that the term ‘decentralisation’ is often so poorly defined \nthat reforms made in its name cannot be assessed to see if they have achieved it as \na goal or not. The article explores the meanings of decentralisation and attempts \nto clarify it, before go…
The 'Second Black Report'? The Acheson Report as Another Opportunity to Tackle Health Inequalities
(2002). The 'Second Black Report'? The Acheson Report as Another Opportunity to Tackle Health Inequalities. Contemporary British History: Vol. 16, No. 3, pp. 175-197
The contribution of coterminosity to joint purchasing in health and social care
The Contest for Control in Community Health Services
General Managers (GMs) represent a relatively new cadre in the British National Health Service (NHS) who have become closely aligned with central government policy in recent years. GMs have increasingly been appointed to local levels in the NHS which could potentially lead to a clash with other professional domains. This paper uses the example of a decentralisation policy to trace the contest between GMs and professionals during its implementatio…
The contribution of coterminosity to joint purchasing in health and social care
Clinical Audit in the NHS internal market
Relations between managers and professionals in the public sector have often centred on the control of work performance. Work performance strategies and techniques have been transformed by recent public sector policies involving managerialisation and quasi-markets. In particular, the clinical audit programme in the National Health Service has traditionally been the preserve of professionals, mainly doctors but managers and purchasers have become …
Primary care in the UK
The United Kingdom is ostensibly one country and yet public policy often varies between its constituent territories - England, Scotland, Wales and Northern Ireland. Health policy illustrates the dilemmas inherent in an apparently unitary system that permits scope for territorial variation. Administrative devolution has now been accompanied by political devolution but their interaction has yet to produce policy outcomes. This paper describes recen…
The 'Second Black Report'? The Acheson Report as Another Opportunity to Tackle Health Inequalities
(2002). The 'Second Black Report'? The Acheson Report as Another Opportunity to Tackle Health Inequalities. Contemporary British History: Vol. 16, No. 3, pp. 175-197
Geographies of Care
How great expectations in Westminster may be dashed locally
English Tackling health inequalities is a policy priority for the Labour government in the UK. We use Kingdon’s model of ‘policy streams’ to explain how the issue of health inequalities gets onto the policy agenda nationally and locally, and how it is being implemented. Using empirical evidence from local agencies, we suggest that the issue of health inequalities is on the agenda nationally and locally but implementation is hampered by deficienci…
Equal Access to Health Care and the British National Health Service
Equal access to health care is a central objective of many health care systems, and is often seen as the founding principle of the British National Health Service. However, this paper argues that it can be seen as a piece of grand or flamboyant rhetoric of symbolic politics, representing a misreading, or at least an oversimplification, of history. It examines stated equity objectives in the NHS by placing them in the cells of an equity matrix. It…
The role of performance indicators in changing the autonomy of the general practice profession in the UK
Big Windows and Little Windows
This paper argues for the need to re‐assess models of policy implementation in the ‘congested state’. This re‐appraisal focuses on two main directions. The first involves locating implementation in the context of wider models of the policy process. We fuse three models, those of Kingdon, Wolman, and Challis et al ., to form a new ‘policy streams’ approach. The second examines implementation in multi‐level governance. In the UK and elsewhere, much…
Access, Choice and Travel
The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be th…
Room for manoeuvre?
Policy to tackle the social determinants of health
Like health equity, the social determinants of health (SDH) are becoming a key focus for policy-makers in many low and middle income countries. Yet despite accumulating evidence on the causes and manifestations of SDH, there is relatively little understanding about how public policy can address such complex and intractable issues. This paper aims to raise awareness of the ways in which the policy processes addressing SDH may be better described, …
Decentralizing Health Services in the Uk
Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are …
Has Labour decentralised the NHS? Terminological obfuscation and analytical confusion
This article considers the rise of decentralisation as an approach to public-sector \nreform generally, and its approach to the British National Health Service (NHS) \nspecifically. It suggests that the term ‘decentralisation’ is often so poorly defined \nthat reforms made in its name cannot be assessed to see if they have achieved it as \na goal or not. The article explores the meanings of decentralisation and attempts \nto clarify it, before go…
Shaping Health PolicyCase Study Methods and Analysis
This book examines the role that case studies play in understanding and explaining British health policy. Overall, the chapters cover the key health policy literatures in terms of the policy process, analytical frameworks and some of the seminal moments of the NHS. They have been written by health policy researchers in sociology, social policy, management and organisation studies. The book explores and promotes the case study as an under-used met…
Shaping Health Policy
The Challenge of Joined-Up Government in Tackling Health Inequalities
Joined-up government (JUG) has been a notable feature of many national governments, not least the UK Labour government (1997 onwards) with its emphasis on welfare modernisation, tackling engrained social problems, and evidence-based policy. This article focuses on the ways in which JUG has been implemented in England although we draw comparisons with the different approaches in Wales and Scotland, as devolution has provided an interesting natural…
The illness narratives of health managers
This paper examines the personal experience of illness and healthcare by health managers through their illness narratives. By synthesising a wider literature of illness narratives and health management, an analytical framework is presented, which considers the impact of illness narratives, comprising the logic of illness narratives, the actors involved and strategies, including the contexts in which those illness narratives are used and the impac…
Policy Entrepreneurship in the Development of Public Sector Strategy
The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter‐related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entr…
Plus ça change, plus c'est la même chose
The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, director…
Towards a Sociology of Disclosure
Despite the increasingly widespread emphasis on the need for transparency in health‐care and elsewhere, there is limited evidence regarding the consequences of disclosing medical performance data. The evidence is disparate and has not been synthesised in a coherent way. This paper focuses on surgical performance, whose measurement is generally often seen as straight forward. It begins by outlining the context for understanding the publication of …
A Framework for Exploring the Policy Implications of UK Medical Tourism and International Patient Flows
It is estimated that over 50,000 individuals from the UK each year elect to fund their own treatment abroad. Such treatments commonly include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The UK has also experienced inward flows of patients who travel to receive treatment and pay out of pocket, being treated in both private and NHS facilities. The rise of ‘medical tour…
Has the British National Health Service (NHS) got talent? A process evaluation of the NHS talent management strategy
In 2004, the British National Health Service (NHS), an organisation with one of the largest workforces in the world, adopted a new approach to identifying and developing managers, which was refreshed in 2009 with ‘guidance for NHS talent and leadership plans'. This paper explores the introduction of talent management (TM) in the British NHS, focusing on process evaluation. It discusses the introduction of TM in the NHS before examining the stated…
Making Health Policy
Alaszewski, A. and Brown, P. Making Health Policy: A Critical Introduction . Cambridge : Polity , 2011 , £16.99 (pbk) ix+ 292 pp : ISBN : 978-0-7456-4174-4 At a time when the Health and Social Care Bill is being implemented across England, it is arguably more important than ever to understand and explain the content, process and impact in health policy. Whilst description of such reforms abound, careful and detailed analysis is sadly often lackin…
Political science (35 works) · Sociology (24 works) · Health care (18 works) · Law (17 works) · Economics (16 works) · Public Administration (15 works) · Business (13 works) · Public relations (13 works) · Law (12 works) · Healthcare innovation and challenges (11 works)