Gerald Wistow
Datos Biográficos
| ID | 272882 |
|---|---|
| NOMBRE | Gerald Wistow |
| NOMBRES | Gerald |
| APELLIDO | Wistow |
| FIRMA | WISTOW G |
| AFILIACIONES | London School of Economics and Political Science |
| ORCID | 0000-0001-9626-6855 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 38 |
| TOTAL DE CITAS | 172 |
| TOTAL COMO AUTOR | 38 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1978 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2024 |
| ÍNDICE H | 9 |
Ready, Willing and Able? Local Perspectives on Implementing Prevention in Social Care in England
There is a growing emphasis on prevention to reconcile demographic pressures, resource scarcity and expectations of better quality care and support. The Care Act 2014 placed a statutory duty on English local authorities to prevent and delay the development of needs for care and support. However, evidence suggests that the prevention approach has secured less impact than intended. Given that existing approaches have achieved such limited results, …
Who should pay for social care for older people in England? Results from surveys of public attitudes to the funding of adult social care
While debate on how best to pay for social care in England continues, information about public attitudes on this issue is limited. We asked representative samples of the public whether care costs for older people should be met by the state, met by the service user or shared between state and user. We used an online survey of people aged 18-75 (n = 3,000) and interview survey of people aged 65 and over (n = 466). Respondents were given four vignet…
The sociocultural framing of public attitudes to sharing the costs of social care for older people in England
Twelve synchronous online focus groups were conducted, each involving four to six members of the general public who had expressed in-principle support for sharing the costs of social care for older people between service users and government. These explored participants' reasons for preferring a shared approach and their views on how costs should be shared, with particular attention given to the sociocultural frames employed. Four main sociocultu…
A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent
Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical S…
Public preferences for paying for social care in later life in England
There is ongoing debate about how the funding system for social care of older people in England should best be reformed. We investigated how public attitudes to individual and state responsibility for paying for social care in later life vary with demographic and socio-economic characteristics. Four vignettes of individuals in need of home care or residential care with varying levels of savings, income and housing wealth were presented to a sampl…
Different Contexts, Similar Challenges. Sustain’s Experiences with Improving Integrated Care in Europe
Improving Person-Centredness in Integrated Care for Older People
Evaluating activities aimed at promoting person-centredness from both the service providers' and service users' perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support
Funding and planning for social care in later life
This study examined people's perceptions and behaviours in relation to planning for their social care needs, and their values and priorities concerning how social care should be funded. Eight deliberative focus groups were conducted in May 2018 with 53 participants, aged 25-82 years, in London, Manchester and rural locations near York and Sheffield. Multiple uncertainties created barriers to planning for social care needs including not knowing ho…
The Sustain Project
SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home
Why Implementing Integrated Care is so much harder than designing it
Introduction: Delivering more integrated care has long been a priority in England. Both care quality and cost effectiveness have been seen to require effective collaboration between local government and the NHS. Despite repeated national programmes and some localised progress, success has never been universalised. The recent Coalition Government launched several initiatives to enable integrated care to ‘become the standard model for everyone with…
Costs and economic consequences of a help-at-home scheme for older people in England
Solutions to support older people to live independently and reduce the cost of an ageing population are high on the political agenda of most developed countries. Help-at-home schemes offer a mix of community support with the aim to address a range of well-being needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals' well-being and the economic cons…
Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme
Does integrated governance lead to integrated patient care? Findings from the innovation forum
Good integration of services that aim to reduce avoidable acute hospital bed use by older people requires frontline staff to be aware of service options and access them in a timely manner. In three localities where closer inter-organisational integration was taking place, this research sought patients' perceptions of the care received across and within organisational boundaries. Between February and July 2008, qualitative methods were used to map…
Can the community construct knowledge to shape services in the local state? A case study
The Labour government's stated commitment to shifting the balance of power to communities, citizens and users has been expressed in numerous initiatives to promote participatory governance in the local state. In this context achieving reliable ways of learning about participants' views becomes critical. A prime concern then becomes what constitutes `community knowledge' and how that knowledge can be developed. This article considers some issues t…
Aspirations and realities
The community care reforms in the United Kingdom were a response to a broadly based critique of the policy's failure. After an apparently successful first year's implementation, their robustness is increasingly under question. This paper reviews evidence about the early implementation of the reforms. While attention has focused on erecting a structure of systems and processes, the foundations of community care are in danger of being undermined by…
Achieving a strategy for user involvement in community care
This paper presents an overview of findings from an evaluation of the Birmingham Community Care Special Action Project (CCSAP). CCSAP was intended to deliver an inter-agency, user-oriented strategy for community care. It pre-dated the reforms introduced by the National Health Service and Community Care Act and, indeed, may have influenced some aspects of those reforms. Lessons from the evaluation can assist agencies wishing to develop a strategy …
The user perspective on managing for health outcomes
The Department of Health has placed great importance on evidence-based purchasing rooted in the assessment and measurement of health outcomes. This paper critically examines the conventional clinical effectiveness approach and argues for the integration of a user perspective in defining and determining health outcomes. Some conceptual issues around user involvement in mental health are considered first. Then we draw upon research with users and c…
Publics, Patients, Citizens, Consumers? Power and Decision Making in Primary Health Care
This article uses theoretical approaches to the discussion of power in order to consider the role of public and patient participation in primary health care organizations in the UK. There is considerable evidence to suggest that, despite major national initiatives to extend participation in health services, the role of participation in decision making remains underdeveloped. The primary purpose of this article is to understand how and why this sh…
Governance and public involvement in the British National Health Service
Movement and change
Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care provid…
In Pursuit of Inter-Agency Collaboration In The Public Sector
Although long seen as desirable, inter-agency collaboration has remained conceptually elusive and difficult to achieve. Whilst recognising that there are other positions, this article takes the normative position that collaboration is generally a ‘good thing’. It brings together strands of theoretical, conceptual and empirical literature from diverse disciplines in ‘order to better understand inter-agency collaboration as a concept and as a proce…
Dimensions of choice in the assessment and care management process
The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from w…
Continuing health care
In 1995 the Department of Health issued guidance on continuing health care following the health service commissioner's finding against Leeds Health Authority for failing to provide long-term care. Under this guidance, health authorities were required to agree continuing health care policies and eligibility criteria with fundholders and local authorities. This study sought to investigate the extent to which the drafting of local policies and crite…
Securing Quality Through Contracts? The Development of Quasi‐markets for Social Care in Britain
This article examines the early development in Britain of quasi‐markets for domiciliary care. Initially there were widespread doubts about the appropriateness of market mechanisms for social care because it was regarded as inherently different from other goods and services. We examine these differences and how they are most apparent in domiciliary care — which is provided to the most vulnerable people in the most vulnerable of settings. The study…
Rationality and Rhetoric
Between 1982 and 1992 Roy Griffiths, then Managing Director of the Sainsbury supermarket chain, wrote two reports which led to significant changes in the organization and management of health and social services in the UK. This article provides a detailed account of the policy process which led to the latter of these reports, which dealt with community care, in order to assesses Griffiths’ personal contribution to policy making
User Involvement in Community Care
Whilst the drive towards public sector consumerism is intensifying, it is also evident that somewhat different ‘brands’ of consumerism are currently being marketed. This article develops a framework to assist in the disaggregation and understanding of the range of approaches to consumerism currently being pursued in the field of health and social care. Its principal elements concern the ideological origins of consumerism in this field; their purp…
From Providing to Enabling
Government policy seeks to introduce competition into the supply of social care through the separation of purchasing and providing responsibilities. A study of 24 local authority social service departments has explored the initial steps taken to prepare for the new enabling role, including the creation of a mixed economy of care. Very few were seeking to create a market in social care. Most argued that the inherent nature of social care rendered …
Dimensions of choice in the assessment and care management process
The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from w…
The Sustain Project
SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home
Does integrated governance lead to integrated patient care? Findings from the innovation forum
Good integration of services that aim to reduce avoidable acute hospital bed use by older people requires frontline staff to be aware of service options and access them in a timely manner. In three localities where closer inter-organisational integration was taking place, this research sought patients' perceptions of the care received across and within organisational boundaries. Between February and July 2008, qualitative methods were used to map…
Publics, Patients, Citizens, Consumers? Power and Decision Making in Primary Health Care
This article uses theoretical approaches to the discussion of power in order to consider the role of public and patient participation in primary health care organizations in the UK. There is considerable evidence to suggest that, despite major national initiatives to extend participation in health services, the role of participation in decision making remains underdeveloped. The primary purpose of this article is to understand how and why this sh…
The Purchaser/Provider Split in English Health Care
An important feature of the post-Working for Patients National Health Service is the introduction of quasi-markets in health care, to be created by separating the ‘purchaser’ and ‘provider’ functions formerly conflated in the role of District Health Authorities. This paper presents data from a study of the first few months of operation of the new system, focusing upon the role of purchasing authorities in rationing health care and in legitimising…
Aspirations and realities
The community care reforms in the United Kingdom were a response to a broadly based critique of the policy's failure. After an apparently successful first year's implementation, their robustness is increasingly under question. This paper reviews evidence about the early implementation of the reforms. While attention has focused on erecting a structure of systems and processes, the foundations of community care are in danger of being undermined by…
Movement and change
Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care provid…
Public Expenditure and Policy Implementation
This article explores the contention that the conventions of public expenditure accounting conceal, rather than reveal, the real nature and implications of resource trends. A benchmark — a constant level of service output — is established as a basis for examining the relationship between trends in expenditure inputs and service outputs. Changes in unit costs are identified as the major source of deviation between expenditure and output trends. Th…
Governance and public involvement in the British National Health Service
Competition in the Mixed Economy of Care
The 1990National Health Service and Community Care Actintroduced sweeping changes to health and social welfare services. The reforms to community care were dominated by the introduction of markets for social care. We argue that the new markets cannot be guaranteed to deliver the range of services required to meet community care objectives. When they began to assume their new responsibilities, few key purchasers had a basic understanding of the fu…
Securing Quality Through Contracts? The Development of Quasi‐markets for Social Care in Britain
This article examines the early development in Britain of quasi‐markets for domiciliary care. Initially there were widespread doubts about the appropriateness of market mechanisms for social care because it was regarded as inherently different from other goods and services. We examine these differences and how they are most apparent in domiciliary care — which is provided to the most vulnerable people in the most vulnerable of settings. The study…
Collaboration between Health and Local Authorities
In contrast with current proposals, collaboration with local government was a dominant factor in the 1974 reorganisation of the NHS. Four categories of such collaboration are identified in this paper: the sharing of services; coordination of service delivery; joint planning; and joint prevention. The need for each is discussed in the context of the reorganisation debate and of subsequent events. In essence, the DHSS case for collaboration — and i…
Public preferences for paying for social care in later life in England
There is ongoing debate about how the funding system for social care of older people in England should best be reformed. We investigated how public attitudes to individual and state responsibility for paying for social care in later life vary with demographic and socio-economic characteristics. Four vignettes of individuals in need of home care or residential care with varying levels of savings, income and housing wealth were presented to a sampl…
The user perspective on managing for health outcomes
The Department of Health has placed great importance on evidence-based purchasing rooted in the assessment and measurement of health outcomes. This paper critically examines the conventional clinical effectiveness approach and argues for the integration of a user perspective in defining and determining health outcomes. Some conceptual issues around user involvement in mental health are considered first. Then we draw upon research with users and c…
The Paradox of Policy Diversity in a Unitary State
Studies of policy‐making and management in health and related fields have generally been confined to England even when professing to embrace Britain or the United Kingdom. The assumption of a unitary state in which the policy lead is given by Westminster/Whitehall is shown to be grossly misleading in the case of community care policy. Considerable variations exist not only in policy means but also in policy ends. The paper demonstrates the limita…
Reducing emergency bed-days for older people? Network governance lessons from the 'Improving the Future for Older People' programme
Achieving a strategy for user involvement in community care
This paper presents an overview of findings from an evaluation of the Birmingham Community Care Special Action Project (CCSAP). CCSAP was intended to deliver an inter-agency, user-oriented strategy for community care. It pre-dated the reforms introduced by the National Health Service and Community Care Act and, indeed, may have influenced some aspects of those reforms. Lessons from the evaluation can assist agencies wishing to develop a strategy …
Ready, Willing and Able? Local Perspectives on Implementing Prevention in Social Care in England
There is a growing emphasis on prevention to reconcile demographic pressures, resource scarcity and expectations of better quality care and support. The Care Act 2014 placed a statutory duty on English local authorities to prevent and delay the development of needs for care and support. However, evidence suggests that the prevention approach has secured less impact than intended. Given that existing approaches have achieved such limited results, …
The sociocultural framing of public attitudes to sharing the costs of social care for older people in England
Twelve synchronous online focus groups were conducted, each involving four to six members of the general public who had expressed in-principle support for sharing the costs of social care for older people between service users and government. These explored participants' reasons for preferring a shared approach and their views on how costs should be shared, with particular attention given to the sociocultural frames employed. Four main sociocultu…
A critical systems evaluation of the introduction of a ‘discharge to assess’ service in Kent
Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical S…
Improving Person-Centredness in Integrated Care for Older People
Evaluating activities aimed at promoting person-centredness from both the service providers' and service users' perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support
Costs and economic consequences of a help-at-home scheme for older people in England
Solutions to support older people to live independently and reduce the cost of an ageing population are high on the political agenda of most developed countries. Help-at-home schemes offer a mix of community support with the aim to address a range of well-being needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals' well-being and the economic cons…
Continuing health care
In 1995 the Department of Health issued guidance on continuing health care following the health service commissioner's finding against Leeds Health Authority for failing to provide long-term care. Under this guidance, health authorities were required to agree continuing health care policies and eligibility criteria with fundholders and local authorities. This study sought to investigate the extent to which the drafting of local policies and crite…
Managing housing policy—the implementation of policy in the owner occupied sector
Collaboration between Health and Local Authorities
In contrast with current proposals, collaboration with local government was a dominant factor in the 1974 reorganisation of the NHS. Four categories of such collaboration are identified in this paper: the sharing of services; coordination of service delivery; joint planning; and joint prevention. The need for each is discussed in the context of the reorganisation debate and of subsequent events. In essence, the DHSS case for collaboration — and i…
Public Expenditure and Policy Implementation
This article explores the contention that the conventions of public expenditure accounting conceal, rather than reveal, the real nature and implications of resource trends. A benchmark — a constant level of service output — is established as a basis for examining the relationship between trends in expenditure inputs and service outputs. Changes in unit costs are identified as the major source of deviation between expenditure and output trends. Th…
Joint Finance
British government policy has long aimed at substituting local government community services for centrally-funded long-stay hospital services. Thus, the health service has depended on the willingness of locally administered and financed services to accept a shift in the balance of care. A special financial programme—joint finance—was introduced in 1976 to provide local authorities with an incentive to implement this shift. The programme apparentl…
The Paradox of Policy Diversity in a Unitary State
Studies of policy‐making and management in health and related fields have generally been confined to England even when professing to embrace Britain or the United Kingdom. The assumption of a unitary state in which the policy lead is given by Westminster/Whitehall is shown to be grossly misleading in the case of community care policy. Considerable variations exist not only in policy means but also in policy ends. The paper demonstrates the limita…
Joint Approaches to Social Policy
This book is in essence concerned with the quest for rationality in decision-making, and is founded on the premise that improvements in the machinery of decision-making can actually lead to better decisions. The numerous initiatives of the 1960s and 1970s established specifically to foster greater policy coordination (notably the Central Policy Review Staff or 'Think Tank') had, by the beginning of the 1980s, fallen foul of an altogether changed …
Policy Networks and the Implementation of Community Care Policy for People with Mental Handicaps
Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, 'in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this 'implementation gap' in respect of services for people with mental handi…
From Providing to Enabling
Government policy seeks to introduce competition into the supply of social care through the separation of purchasing and providing responsibilities. A study of 24 local authority social service departments has explored the initial steps taken to prepare for the new enabling role, including the creation of a mixed economy of care. Very few were seeking to create a market in social care. Most argued that the inherent nature of social care rendered …
The Purchaser/Provider Split in English Health Care
An important feature of the post-Working for Patients National Health Service is the introduction of quasi-markets in health care, to be created by separating the ‘purchaser’ and ‘provider’ functions formerly conflated in the role of District Health Authorities. This paper presents data from a study of the first few months of operation of the new system, focusing upon the role of purchasing authorities in rationing health care and in legitimising…
User Involvement in Community Care
Whilst the drive towards public sector consumerism is intensifying, it is also evident that somewhat different ‘brands’ of consumerism are currently being marketed. This article develops a framework to assist in the disaggregation and understanding of the range of approaches to consumerism currently being pursued in the field of health and social care. Its principal elements concern the ideological origins of consumerism in this field; their purp…
Halfway There? Policy, Politics and Outcomes in Community Care
The community care reforms which followed the 1989 White Paper “Caring for People”were apparently focused on addressing the needs of people requiring long‐term care, and on achieving improved outcomes and better quality of life. The agenda set out by the White Paper was for community care in the next decade and beyond. Half way through this decade, we question the extent to which the objectives of promoting choice and independence for users and c…
Social Care Markets in England
Recent discussions of health and social care in the United Kingdom have been dominated by the 1990 National Health Service and Community Care Act. A core dimension of the act was to encourage greater mixing of the "economy of care," specifically, greater pluralism in provision, more systematic regulation of practice and assurance of quality, and (in the longer term) greater variety of funding sources. The result has been the development of social…
Competition in the Mixed Economy of Care
The 1990National Health Service and Community Care Actintroduced sweeping changes to health and social welfare services. The reforms to community care were dominated by the introduction of markets for social care. We argue that the new markets cannot be guaranteed to deliver the range of services required to meet community care objectives. When they began to assume their new responsibilities, few key purchasers had a basic understanding of the fu…
Securing Quality Through Contracts? The Development of Quasi‐markets for Social Care in Britain
This article examines the early development in Britain of quasi‐markets for domiciliary care. Initially there were widespread doubts about the appropriateness of market mechanisms for social care because it was regarded as inherently different from other goods and services. We examine these differences and how they are most apparent in domiciliary care — which is provided to the most vulnerable people in the most vulnerable of settings. The study…
Rationality and Rhetoric
Between 1982 and 1992 Roy Griffiths, then Managing Director of the Sainsbury supermarket chain, wrote two reports which led to significant changes in the organization and management of health and social services in the UK. This article provides a detailed account of the policy process which led to the latter of these reports, which dealt with community care, in order to assesses Griffiths’ personal contribution to policy making
In Pursuit of Inter-Agency Collaboration In The Public Sector
Although long seen as desirable, inter-agency collaboration has remained conceptually elusive and difficult to achieve. Whilst recognising that there are other positions, this article takes the normative position that collaboration is generally a ‘good thing’. It brings together strands of theoretical, conceptual and empirical literature from diverse disciplines in ‘order to better understand inter-agency collaboration as a concept and as a proce…
Dimensions of choice in the assessment and care management process
The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from w…
Continuing health care
In 1995 the Department of Health issued guidance on continuing health care following the health service commissioner's finding against Leeds Health Authority for failing to provide long-term care. Under this guidance, health authorities were required to agree continuing health care policies and eligibility criteria with fundholders and local authorities. This study sought to investigate the extent to which the drafting of local policies and crite…
Movement and change
Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care provid…
Publics, Patients, Citizens, Consumers? Power and Decision Making in Primary Health Care
This article uses theoretical approaches to the discussion of power in order to consider the role of public and patient participation in primary health care organizations in the UK. There is considerable evidence to suggest that, despite major national initiatives to extend participation in health services, the role of participation in decision making remains underdeveloped. The primary purpose of this article is to understand how and why this sh…
Governance and public involvement in the British National Health Service
Aspirations and realities
The community care reforms in the United Kingdom were a response to a broadly based critique of the policy's failure. After an apparently successful first year's implementation, their robustness is increasingly under question. This paper reviews evidence about the early implementation of the reforms. While attention has focused on erecting a structure of systems and processes, the foundations of community care are in danger of being undermined by…
Achieving a strategy for user involvement in community care
This paper presents an overview of findings from an evaluation of the Birmingham Community Care Special Action Project (CCSAP). CCSAP was intended to deliver an inter-agency, user-oriented strategy for community care. It pre-dated the reforms introduced by the National Health Service and Community Care Act and, indeed, may have influenced some aspects of those reforms. Lessons from the evaluation can assist agencies wishing to develop a strategy …
The user perspective on managing for health outcomes
The Department of Health has placed great importance on evidence-based purchasing rooted in the assessment and measurement of health outcomes. This paper critically examines the conventional clinical effectiveness approach and argues for the integration of a user perspective in defining and determining health outcomes. Some conceptual issues around user involvement in mental health are considered first. Then we draw upon research with users and c…
Can the community construct knowledge to shape services in the local state? A case study
The Labour government's stated commitment to shifting the balance of power to communities, citizens and users has been expressed in numerous initiatives to promote participatory governance in the local state. In this context achieving reliable ways of learning about participants' views becomes critical. A prime concern then becomes what constitutes `community knowledge' and how that knowledge can be developed. This article considers some issues t…
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