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. Failures in care have been manifest across many different settings. Drawing on examples from care of older people and end-of-life care, as well as from learning disabilities, mental health, maternity care and services for vulnerable children, Neil Small shows that the same sorts of problems are evident across these settings and that they are occurring up to the present day. Discussing culture change alongside levels of funding and the impact of prevailing political and economic orthodoxies, and through the lens of shifts of trust in society, this book argues that the concept of culture must be cast much wider than organisational and professional cultures if change is to be secured. This book engages with how to improve quality of care in the NHS and welfare systems more generally. Its case examples are from the UK but the issues of governance, culture change and shifts in the social contract that failures illuminate have an international relevance. It is important reading for those with an interest in health, social care, political science, and sociology.

This book argues that neoliberal changes in health and social care go beyond resource allocations, priority setting, and privatisation, and manifest in an invidious erosion of the quality of our social relationships, including relationships between care provider and care recipient. Critically examining the concept of culture and why shifts in what is considered 'acceptable practice' happen, the book explores the conduct of conduct. It draws together what we know about neoliberalism's impact on the economy and public services with research around governmentality and social change. Looking at breakdowns in the quality of care in the NHS and social care across a range of settings it holds that macro influences, such as austerity and marketisation, cannot explain everything and many of the damaging things that go on in care breakdowns occur in micro interactions between care provider and care recipient. Analysing the interactions between the calculations of political centres, the strength of professional identities, the effectiveness of oversight and supervision and the biographies of protagonists, Neil Small problematises the focus on culture, and culture change, in our response to care failures and examines what a different approach to care might involve. Exploring the interaction of politics, economics and social change and their impact on healthcare and the wider welfare state, this is an important contribution for students and researchers in health and social care, sociology, political science and management studies.

Opening with a useful overview of the literature on user involvement, the book goes on to look at the policy and professional context within which user involvement is undertaken, in particular user involvement in palliative care. In this section, the authors discuss two key concepts - palliative care and empowerment - and analyse the role of self-help groups and new information and communication technologies in this context. The last section of the book focuses on the detailed narratives of people coping with three life-threatening illnesses - cystic fibrosis, multiple sclerosis and motor neurone disease - and in this way the views and experiences of the 'user' are brought into play to critique current policy and practice
Too Ill to Talk? addresses a current health services issue in a refreshingly critical manner. It challenges the assumption that user involvement is either easy to achieve or that it is necessarily welcomed by all parties. It will be valuable reading for students on health studies courses, health professionals and policy makers in health and social care.

Death, Gender and Ethnicity examines the ways in which gender and ethnicity shape the experiences of dying and bereavement, taking as its focus the diversity of ways through which the universal event of death is encountered. It brings together accounts of how these experiences are actually managed with analyses of a range of representations of dying and grieving in order to provide a more theoretical approach to the relationship between death, gender and ethnicity.
Though death and dying have been an increasingly important focus for academics and clinicians over the last thirty years, much of this work provides little insight into the impact of gender and ethnicity on the experience. The result is often a universalising representation which fails to take account of the personally unique and culturally specific experiences associated with a death. Drawing on a range of detailed case studies, Death, Gender and Ethnicity seeks to develop a more sensitive theoretical approach which will be invaluable reading for students and practitioners in health studies, sociology, social work and medical anthropology.

Improvements in health care in the 21st century mean people are living longer, but with the paradox that chronic illness is increasingly prevalent. Dementia, a term used to describe various different brain disorders that involve a loss of brain function that is usually progressive and eventually severe, is a condition associated with an ageing population and is becoming increasingly common. Worldwide there are approximately 24 million people with dementia, expected to rise to 81 million by 2040. Inevitably, people living with dementia will die, but their needs at the end of life are not well known. This book describes what might be achieved if the values and best practice of both dementia care and palliative care are brought together, to achieve quality end of life care for this specific group of patients. It explores what is known about the experience of dying with dementia, using a narrative approach, and develops a model that draws together a 'person-centred' approach to care. The book examines the possibilities and the challenges faced when trying to improve quality of life for people with dementia, and presents examples of good practice from across the world.