A decade of outsourcing in health and social care in England: What was it meant to achieve?

The increased private provision of publicly funded health and social care over the last 75 years has been one of the most contentious topics in UK public policy. In the last decades, health and social care policies in England have consistently promoted the outsourcing of public services to private for-profit and non-profit companies with the assumption that private sector involvement will reduce costs and improve service quality and access. However, it is not clear why outsourcing often fails to improve quality of care, and which of the underlying assumptions behind marketising care are not supported by research. This article provides an analysis of key policy and regulatory documents preceding or accompanying outsourcing policies in England (e.g., policy document relating to the 2012 and 2022 Health and Social Care Acts and the 2014 Care Act), and peer-reviewed research on the impact of outsourcing within the NHS, adult's social care, and children's social care. We find that more regulation and market oversight appear to be associated with less poor outcomes and slower growth of for-profit provision. However, evidence on the NHS suggests that marketisation does not seem to achieve the intended objectives of outsourcing, even when accompanied with heavy regulation and oversight. Our analysis suggests that there is little evidence to show that the profit motive can be successfully tamed by public commissioners. This article concludes with how policymakers should address, or readdress, the underlying assumptions behind the outsourcing of care services.

Practices and challenges of safety management in outsourced facilities management.

INTRODUCTION: Outsourcing is a commonly occurring organizational activity, but one associated with negative occupational safety outcomes. Improving the management of safety in workplaces where contractors are employed is vital, but under-researched in the service sectors. The aims of this paper were to investigate both the practices and challenges of safety management in outsourced facility management (FM), an important global service sector. METHOD: Twenty-three semi-structured interviews were conducted with clients and contractors in three different FM outsourcing arrangements between large corporations in the UK. Data were thematically coded against frameworks derived from existing literature to identify deployed safety management practices and reveal challenges associated with safety management in these outsourced relationships. RESULTS: Safety management practices in outsourced FM conformed to known practices clustering into four previously identified categories (planning, selecting, on-site working, and checking). A fifth category (reviewing) was not observed. Operating across national boundaries, applying national contracts locally, working with mandated KPIs, and contract specifications all created new challenges for safety management not previously reported. Other known challenges associated with economic pressure and disorganization were observed. CONCLUSION: Safety management practices observed in safety critical industries also apply in FM. However, the challenges of safety management in these three cases included regulatory failures that have not been routinely identified in other empirical studies of safety in outsourcing arrangements. PRACTICAL APPLICATION: Adopting widely accepted safety management practices support safer working in outsourced FM and encourage cross-sector learning. New challenges for safety management noted here encourage consideration of unintended consequences of contract terms and conditions, require corporate agreement on how to ensure safety compliance when working transnationally, and a review of decision-making and processes and procedures to enable effective and safe working locally.

Considerations for developing a health-system 503B outsourcing strategy.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To provide guidance for health systems on how to develop a strategy for utilizing 503B outsourcing facilities for sterile product preparation. SUMMARY: Health-system pharmacies face an increasingly complex set of challenges related to providing sterile products to patients. New United States Pharmacopeia <797> regulations, increasing drug shortages, and an ongoing pharmacy technician workforce shortage have made sterile compounding more difficult than ever for health-system pharmacies. Outsourcing of production to 503B outsourcing facilities is one strategy pharmacy leaders can use to help navigate these challenges. However, there are many factors to consider when deciding whether to outsource a product and which 503B vendors are safe and reliable. The Cleveland Clinic Health System (CCHS) has developed a robust internal structure to appropriately vet 503B outsourcing facilities for safety and reliability, as well as standardized criteria used to determine which products will be outsourced. This article describes the tools CCHS has used to evaluate 503B outsourcing vendors and to evaluate individual products to determine the pros and cons of outsourcing vs insourcing. Additionally, general considerations regarding outsourcing are described. CONCLUSION: Outsourcing to 503B facilities can be an effective strategy for navigating sterile compounding challenges but is not without some risk. Pharmacy leaders must develop a standardized approach to thoroughly evaluate 503B vendors and products to ensure their outsourcing strategy is both safe and cost-effective.

Carbon Abatement and Leakage in China's Regional Carbon Emission Trading.

Emission trading schemes (ETS) are increasingly becoming a popular policy instrument to balance carbon abatement and economic growth. As a globally unified carbon pricing system has not yet been established, whether regionally operated ETSs cause carbon leakage remains a major concern. Taking China's regional pilot ETSs as a quasi-natural experiment, the study uses the spatial difference-in-differences method to examine how regional ETSs affect carbon emissions in and outside cities of policy implementation. Our analysis finds that China's regional ETS policy contributes to a 6.1% reduction in urban CO2 emissions and a 6.6% decline in emissions intensity in regulated cities, causing carbon leakages that increase CO2 emissions in neighboring cities by 1.7% on average. Our finding further suggests that regional ETSs mitigate local CO2 emissions through outsourcing production, improving energy efficiency and decarbonizing energy structure, whereas the outsourcing of industrial production drives up CO2 emissions in adjacent cities. Moreover, the performances of regional ETSs vary largely by socioeconomic context and mechanism design. China's regional ETSs reduce CO2 emissions more effectively in central and industrial cities but with more severe carbon leakage, while rigorous compliance mechanisms and active market trading help deepen carbon abatement and alleviate carbon leakage.

A systematic literature review of logistics services outsourcing.

Logistics is critical in every company's supply chain (SC), and outsourcing helps businesses concentrate on their core competencies. Third-party logistics (3 PL) or logistics service providers (LSPs) assist businesses in cutting costs while improving performance, sustainability, and revenue. Logistics evaluation and LSPs choice are complicated and critical components of value delivery. This study aims to review logistics outsourcing literature to understand the trends, prospects, factors, and strategies used in logistics companies' outsourcing choices. This work examines the literature on LSPs selection published between 2010 and 2023. This paper uses VOSviewer (version 1.6.19) to visualize the relationships. Pricing, timely shipment, service quality, reliability, agility, technology, and consumer feedback are the most commonly utilized, whereas societal and environmental factors are seldom used. The study comprises journal publications, the year, selection criteria, and assessment methodologies. Numerous scholars have discovered and employed many critical selection criteria. Many investigators have also embraced multi-criteria decision-making (MCDM) methodologies, and their fuzzy form is widely used. In conclusion, recommendations for theorists and managers, limits, and future directions for research are offered.

The undeclared use of third-party service providers in academic publishing is unethical: an epistemic reflection and scoping review.

There is a substantial body of scientific literature on the use of third-party services (TPS) by academics to assist as "publication consultants" in scholarly publishing. TPS provide a wide range of scholarly services to research teams that lack the equipment, skills, motivation, or time to produce a paper without external assistance. While services such as language editing, statistical support, or graphic design are common and often legitimate, some TPS also provide illegitimate services and send unsolicited e-mails (spam) to academics offering these services. Such illegitimate types of TPS have the potential to threaten the integrity of the peer-reviewed scientific literature. In extreme cases, for-profit agencies known as "paper mills" even offer fake scientific publications or authorship slots for sale. The use of such illegitimate services as well as the failure to acknowledge their use is an ethical violation in academic publishing, while the failure to declare support for a TPS can be considered a form of contract fraud. We discuss some literature on TPS, highlight services currently offered by ten of the largest commercial publishers and expect authors to be transparent about the use of these services in their publications. From an ethical/moral (i.e., non-commercial) point of view, it is the responsibility of editors, journals, and publishers, and it should be in their best interest to ensure that illegitimate TPS are identified and prohibited, while publisher-employed TPS should be properly disclosed in their publications.

Commodification and healthcare in the third sector in England: from gift to commodity-and back?

IMPACT: This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner-provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations. ABSTRACT: When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020-2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified.

Standalone Regulatory Agreements for Product-Development Collaborations in the Medical Products Industry.

BACKGROUND: Medical-product companies often outsource research and manufacturing needs to contracting or partnering organizations but then must manage a challenging patchwork of regulatory activities. A standalone regulatory agreement could clarify the relationships and responsibilities between companies working jointly on a single regulated product. This study explored the need for and current use of standalone regulatory agreements. METHODS: A survey instrument was developed using an implementation framework and disseminated to mid- to senior-level employees and consultants for sponsor and vendor companies in the medical products sector. RESULTS: Of 294 respondents, about half, primarily from companies with more than 200 employees, were familiar with standalone regulatory agreements, and half of this subgroup had moved forward to implement them. Such agreements were considered beneficial to clarify regulatory roles and responsibilities, standardize regulatory expectations between the companies, and stimulate earlier discussion about joint regulatory strategies. However, the development of regulatory agreements appears challenged by the fact that such agreements are not required by regulatory agencies overseeing medical products and have no standardized templates, agency or industry guidance. Respondents whose organizations do not now use regulatory agreements either had not considered or did not see a need for a standalone agreement. CONCLUSIONS: Standalone regulatory agreements are becoming more common but are not yet implemented fully by most companies. Their usefulness and content appeared to depend upon the type of partner, the complexity of the relationship and the availability of internal expertise and support.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study.

BACKGROUND: Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS: This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS: In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS: The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Privatisation of government services in Australia: what is known about health and equity impacts.

BACKGROUND: Historically in Australia, all levels of government created collective wealth by owning and operating infrastructure, and managing natural assets, key public goods and essential services while being answerable to the public. This strong state tradition was challenged in the 1980s when privatisation became a widespread government approach globally. Privatisation involves displacing the public sector through modes of financing, ownership, management and product or service delivery. The Australian literature shows that negative effects from privatisation are not spread equitably, and the health and equity impacts appear to be under-researched. This narrative overview aims to address a gap in the literature by answering research questions on what evidence exists for positive and negative outcomes of privatisation; how well societal impacts are evaluated, and the implications for health and equity. METHODS: Database and grey literature were searched by keywords, with inclusion criteria of items limited to Australia, published between 1990 and 2022, relating to any industry or government sector, including an evaluative aspect, or identifying positive or negative aspects from privatisation, contracting out, or outsourcing. Thematic analysis was aided by NVivo qualitative data software and guided by an a-priori coding frame. RESULTS: No items explicitly reflected on the relationship between privatisation and health. Main themes identified were the public cost of privatisation, loss of government control and expertise, lack of accountability and transparency, constraints to accessing social determinants of health, and benefits accruing to the private sector. DISCUSSION: Our results supported the view that privatisation is more than asset-stripping the public sector. It is a comprehensive strategy for restructuring public services in the interests of capital, with privatisation therefore both a political and commercial determinant of health. There is growing discussion on the need for re-nationalisation of certain public assets, including by the Victorian government. CONCLUSION: Privatisation of public services is likely to have had an adverse impact on population health and contributed to the increase in inequities. This review suggests that there is little evidence for the benefits of privatisation, with a need for greater attention to political and commercial determinants of health in policy formation and in research.

Blockchain-enabled infrastructural security solution for serverless consortium fog and edge computing.

The robust development of the blockchain distributed ledger, the Internet of Things (IoT), and fog computing-enabled connected devices and nodes has changed our lifestyle nowadays. Due to this, the increased rate of device sales and utilization increases the demand for edge computing technology with collaborative procedures. However, there is a well-established paradigm designed to optimize various distinct quality-of-service requirements, including bandwidth, latency, transmission power, delay, duty cycle, throughput, response, and edge sense, and bring computation and data storage closer to the devices and edges, along with ledger security and privacy during transmission. In this article, we present a systematic review of blockchain Hyperledger enabling fog and edge computing, which integrates as an outsourcing computation over the serverless consortium network environment. The main objective of this article is to classify recently published articles and survey reports on the current status in the domain of edge distributed computing and outsourcing computation, such as fog and edge. In addition, we proposed a blockchain-Hyperledger Sawtooth-enabled serverless edge-based distributed outsourcing computation architecture. This theoretical architecture-based solution delivers robust data security in terms of integrity, transparency, provenance, and privacy-protected preservation in the immutable storage to store the outsourcing computational ledgers. This article also highlights the changes between the proposed taxonomy and the current system based on distinct parameters, such as system security and privacy. Finally, a few open research issues and limitations with promising future directions are listed for future research work.

Evaluation of outstanding theories in outsourcing with practices in the public health sector: The case of Türkiye.

Outsourcing is an essential tool in supply management. This study examines the current outsourcing application areas of the public health sector in Türkiye. Application examples are presented, together with the prominent theories in outsourcing (Transaction Cost Economics Theory (TCE), Core Competencies Theory (CCT), Agency Theory (AT), Resource-Based View Theory (RBVT), Relational Theory (RT), and Social Change Theory (SCT), Turkish public procurement legislation, Ministry of Health outsourcing practices, and public hospitals are discussed for review and example. The examination shows that foreign dependency on the public health sector is increasing, and more than one theory is applied in some procurement processes. As a result of this study, examining and comparing which theories come to the fore in outsourcing in other countries is recommended.

Integrative Review of Workplace Health Promotion in the Business Process Outsourcing Industry: Focus on the Philippines.

Objective: The Business Process Outsourcing (BPO) industry in the Philippines has experienced substantial growth, making a significant contribution to the country's economy. However, concerns about work-related health and safety issues have emerged, necessitating effective workplace health promotion strategies for BPO employees. Study design: An integrative review of relevant literature was conducted to explore workplace health promotion in the BPO sector. Methods: The search included quantitative, qualitative, and mixed-method studies, pertinent laws, policies, news articles, and reports published between 2000 and 2022. The scope was intentionally broad to encompass a diverse range of relevant evidence related to workplace health in this field. Articles published both in the English and Filipino languages were considered. Results: Findings revealed that BPO workers face risks related to physical and psychological stress, sleep disturbances, and occupational diseases owing to the unique challenges inherent to the nature of their jobs. While there are existing occupational health and labor laws, compliance among BPO companies remains a problem, and only a few organizations offer comprehensive wellness programs. Building upon the available evidence, a conceptual framework was developed to provide guidance for enhancing workplace health promotion initiatives specifically designed for BPOs in the country. Conclusion: Workplace health promotion is vital to warrant the health and safety of BPO workers. This study offers evidence-based recommendations for implementing effective well-being strategies, highlighting the importance of collaboration among employers, employees, and society to prioritize employee health in the workplace.

Changes in University Hospital Physicians' Work and Family Lives Following Outsourcing of Housework Cleaning Tasks.

Background: Japan is reviewing how physicians operate and plans to implement a work-style reform for physicians in 2024. This study examined how outsourcing housework cleaning tasks changed the daily lives of university hospital physicians. Methods: A total of 18 physicians participated in the study, outsourcing cleaning tasks either once or thrice. Results: Fourteen out of 18 respondents reported a decrease in the burden of household chores. Additionally, 10 respondents reported having more time for family contact, and nine respondents reported having more time for their own hobbies and diversions. Meanwhile, only five respondents reported that they had more time to work. Conclusion: Outsourcing housework cleaning tasks and using the newly created time for family and self may improve work performance.

A trusted medical data sharing framework for edge computing leveraging blockchain and outsourced computation.

Traditional cloud-centric approaches to medical data sharing pose risks related to real-time performance, security, and stability. Medical and healthcare data encounter challenges like data silos, privacy breaches, and transmission latency. In response to these challenges, this paper introduces a blockchain-based framework for trustworthy medical data sharing in edge computing environments. Leveraging healthcare consortium edge blockchains, this framework enables fine-grained access control to medical data. Specifically, it addresses the real-time, multi-attribute authorization challenge in CP-ABE through a Distributed Attribute Authorization strategy (DAA) based on blockchain. Furthermore, it tackles the key security issues in CP-ABE through a Distributed Key Generation protocol (DKG) based on blockchain. To address computational resource constraints in CP-ABE, we enhance a Distributed Modular Exponentiation Outsourcing algorithm (DME) and elevate its verifiable probability to "1". Theoretical analysis establishes the IND-CPA security of this framework in the Random Oracle Model. Experimental results demonstrate the effectiveness of our solution for resource-constrained end-user devices in edge computing environments.

Talent outsourcing in Ghana: A qualitative study of managed service personnel and technology leadership.

Managed Service Personnel (MSPs) have become critical sources of innovation, expertise and superior technology-enhanced performance. This understanding has, however, generated conflicting outcomes, as some hold a contrary view. This study examined the contribution of MSPs to achieving organizational targets in the northern cluster of a reputable bank in Ghana in order to determine the bank's outsourcing decisions, MSP responsibilities, and how such roles compare with those of permanent staff of the bank. The study employed qualitative approaches involving group and individual interviews with 66 participants. The investigation revealed that, among others, the bank outsourced MSPs for expertise, technology, innovation, and cost efficiency. It was also determined that MSPs outperformed regular staff in the areas of technology-enabled productivity, profitability, quality services, and organizational efficiency using unmatched skills, experience, and expertise. A novelty of the study is the culmination of new insight into a performance outlook developed to help organizational leaders make informed decisions. The performance outlook also present critical implications for theory, policy, and practice.

'Accident and emergency'? Exploring the reasons for increased privatisation in England's NHS.

England's NHS is experiencing rising privatisation as services are increasingly being delivered by private healthcare providers. This has led to concerns about the supposed benefit of this process on healthcare quality but the reasons for the increase - and whether processes prioritise quality - are not well understood. In-depth semi-structured interviews with 20 people involved in the commissioning process, sampled from 3 commissioning sites (regional health boards) are thematically analysed. Four key themes of reasons for outsourcing were identified: unmet need; the "choice agenda"; appetite for change amongst key individuals working at the commissioning body; and the impact of financial pressures. The study concludes that the experience of commissioners navigating the provision of healthcare with worsening social determinants of health and financial austerity means that decisions to use private providers based on anticipated quality are sometimes but not always possible - sometimes they constitute 'accidents', sometimes 'emergencies'.

Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study.

BACKGROUND: Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively. OBJECTIVE: This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users' acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention's preliminary efficacy, thus benefiting practitioners and researchers. METHODS: This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti-pressure ulcer mattresses. RESULTS: Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti-pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (-2.7 min) and anti-pressure ulcer mattresses (-3.1 min), as well as shorter delivery times for wheelchairs (-0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful. CONCLUSIONS: This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions.

[Management Practice of Outsourcing Hospital Tests to Independent Clinical Laboratories].

With the development of medical technology and the deepening of medical reform, hospital laboratory test continues to expand. Affected by factors such as technology and cost, the business of outsourcing laboratory test to independent clinical laboratories develops rapidly. However, this cooperation mode has not been carried out for a long time and lacks systematic management experience. Through the analysis of the motivation of hospital delivery, this study expounds the classification, judgment basis and requirements for suppliers of third-party clinical laboratory delivery, as well as the operation practice of laboratory test delivery, so as to provide reference for more standardized and effective testing delivery for hospitals.

What we know about the trends, prospects, and challenges of human resource outsourcing: A systematic literature review.

This study aims to comprehensively review the literature on human resource outsourcing (HRO) published from 2001 to 2021. The study begins with metadata analysis on 69 papers and presents insights into 32 papers on HRO identified from the Scopus and ISI Web of Science databases. The literature is classified based on content analysis, which comprises conceptual understanding, drivers and barriers, functions outsourced, and firm performance. The study reveals that cost advantage, organisational learning, and the opportunity to concentrate on core business functions motivate the organisation to practice HRO. However, the lack of psychological contact among current employees, the risk of opportunism in the freelancing organisation, lack of management legislation, and prior experience are the common barriers to HRO adoption. Despite thesedrawbacks and barriers, recruitment, payroll processing, and technology-centric human resource (HR) activities are standard HR functions outsourced by organisations. The contributions of this study are to offer an integrated and conclusive definition of HRO and provide a simple, easy-to-understand, yet comprehensive framework for understanding HRO practices in any organisation. Researchers and academicians can utilize this paper to explore future research directions while gaining a thorough understanding of the HRO concept.