Jane Lethbridge BA, MA, MSc, MA in HE, PhD, PGCHE, FHEA

Jane Lethbridge led a Masters in Public Administration (MPA) programme from 2007-10. She was international coordinator for international partnerships in the Department of International Business & Economics from 2010-2013. She was Director of the Public Services International Research Unit (PSIRU) from 2013-2018.

Advisory board of Teaching Public Administration

Jane Lethbridge's main research interests include:

• Global commercialisation of health and social care
• Social dialogue in the health and social care sectors in Europe
• Impact of public sector reforms on public sector workers
• Trade union responses to liberalisation and privatisation
• Professionals improving public services

The value of Jane Lethbridge's work since she started as a senior research fellow with the Public Services International Research Unit (PSIRU), in 2001, has been to highlight the growing involvement of for-profit companies in public sector healthcare systems across the world. This research has identified the similarities in the health sector reforms that allow for-profit companies to access public sector health systems. She has provided an analysis of company strategies in the healthcare sector, which is unusual in the field of healthcare policy where the focus is more often on government healthcare policy. She has also contributed to a greater understanding of the processes of social dialogue at a European level in both health care and social care, through some participant observer research into the creation of a European level social dialogue committee in the hospital sector. She has recently taken part, as a European research coordinator, in the first stage of the development of a European level social dialogue committee in the social services sector, which is expected to be extended with EU funding. She was involved in the research between 2012 and 2019 for 'Project PESSIS: Promoting Employers' Social Services in Social Dialogue' (PESSIS, PESSIS 2, PESSIS 3, PESSIS +) coordinating 25 national case studies of social dialogue in the social services sector and writing a Final European Report which provides an overview of trends across Europe.

Key funded projects

'A Parallel Approach to Analysis of Costs/Benefits and Efficiency Changes Resulting From Privatisation of Health Services'

Public Services International (PSI) commissioned this study as a way of drawing together evidence of the impact of health care privatisation on service users and health workers. Although informed by studies in water and municipal services, which have not found evidence of lower cost with private production, designing a study for the health care sector is more complicated because of some of the difficulties in measuring the costs and benefits of health services as well as the efficiency and effectiveness of health service delivery.

Aims of research

To review evidence showing the impact of marketisation and privatisation on health care workers, on service delivery and service users and identify implications for the future.

Results

There are recognisable steps in the process of moving from a state/ government run health care system to a marketised and privatised system but this can take place over many years. It is a more complex process than the privatisation of public utilities.

One of the most significant changes is the introduction of decentralisation policies which transfer responsibility for management and funding from national/ central government to local level. Decentralisation is presented as benefiting local people because it gives greater control over decision making but when linked to reduced resource allocation from government with no balancing powers of local taxation, the result is often a reduction in resources, leading to cuts in services.

Corporatisation or self-management of hospitals accompanied by reduced central funding change the ways in which a public health care institution operates, which results in hospitals being more concerned with reducing the costs of service delivery than with delivering improved quality of care. The status and integrity of health workers is directly affected by decentralisation and other health reforms. Cutting costs of labour intensive activities, such as health and social care results, results in cuts in the labour force or reductions in salaries. This affects the quality of care. For health workers, reductions in salaries and irregularly paid salaries, forces them to secure alternative sources of income.

Areas for future research

Marketisation and privatisation of health care promoted the need for effectiveness, efficiency and equity but implementation and the resulting research has focused on effectiveness and efficiency. Research into health care efficiency has used methodologies and instruments that were created for measuring industrial efficiency, developed for the private sector. Health care is not an industrial production process but depends on the quality of care. There is a lack of quality measures of health and social care. Future research needs to address ways of measuring in quantitative and qualitative ways, what is quality health and social care.

'Project PESSIS: Promoting Employers' Social Services in Social Dialogue'

Health and social care is one of the European Union's fastest growing economic sectors, generating about 5% of total economic output (European Commission, 2010). However, the social services sector faces problems of recruitment and retention because of low pay, the low status of caring as an occupation and poor working conditions. Social services workers are employed by public, private and not-for-profit employers, with a trend for greater provision by private and not-for-profit providers. Union representation of social services workers is also lowest in these two sectors. The implication of this diverse coverage for trade union action is that social dialogue is necessary if workers and employers were to work together to deliver quality services with improved working conditions. Social dialogue is the essential link between quality social services and pay and working conditions but is little understood across Europe.

Aims of research

To map the size of the social services sectors in 11 European countries in terms of workforce and aggregate value of the sector, the level of representation of employers and workers covered by collective agreements, the types of social dialogue that exist, the level of involvement of employers in social dialogue and labour issues that would best be covered at European level.

Results

Poor working conditions, problems with the shortage and retention of staff, lack of training opportunities, special needs of women workers, mobility and working time are all issues that face the social services sector in many European countries. Social dialogue in the social services sector is not organised at European Union (EU) level or sectoral level. The not-for-profit sector is expanding fast and becoming a significant employer in all countries. The European social services sector is heterogeneous and underrepresented. Further data is needed to better understand how social dialogue is sustained in the social services sector in the eleven PESSIS study countries and in other European countries, especially in central and Eastern Europe.

Areas for future research

To identify how social dialogue can be sustained in countries where there are already social dialogue structures. To identify approaches to promoting social dialogue in countries where social dialogue does not exist.

'Democratic Professionalism in Public Services'

Aims of research

Democratic professionalism is an approach that enables public service professionals to work more democratically with clients, patients, students and other public service users. This research aimed to explore what it means to act in a democratic way and to identify practical guidance which will help public professionals to ensure users are at the centre of public service delivery.

Results

Reacting to the marketisation and privatisation of public services, responding to crisis and reflecting on professional practice are three of the main reasons why public professionals take action to work in a more democratic way. What this means in practice can be characterised as valuing of a wide range of expertise, listening to and valuing the views of users, valuing a wide range of expertise and creating a shared language and democratic spaces. The results were published as a book 'Democratic Professionalism in Public Services' by Policy Press in 2019.

Areas for future research

To examine what the democratisation of expertise means and how it can be realised in different sectors and settings.

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