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In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue. [ABSTRACT FROM AUTHOR]

Focusing on the government-led health service in the UK, this paper explores the experiences of family caregivers, responsible for co-ordinating the healthcare of older adults experiencing vulnerability during the pandemic. Data were collected through a 6-month covert netnography, culminating in 322 relevant forum topics and 2607 posts. The findings reveal that both ageing consumers and their carers experience service captivity, which leads to vulnerability. Furthermore, older adults experience vulnerability most when service cessation occurs, involving premature discharge from hospital, eviction from care homes and in-home caregivers withdrawing services, leaving the consumer without an essential health service. Recommendations are made to health service organisations to aid in preventing service captivity and cessation in government-led health services, especially during times of crisis. [ABSTRACT FROM AUTHOR]

The UK Supreme Court ruling of Montgomery v Lanarkshire clarified that in obtaining informed consent to treatment, practitioners are under a duty to inform patients of material risks. Traditionally such risk has pertained to the clinical risks inherent to treatment. In examining empirical and judicial evidence, this paper makes the case for disclosure of potent financial interests; with potency relating to those interests likely to have greatest influence over practice. The paper explores how financial interests may detrimentally influence practice patterns and how non-disclosure of such interests may be linked to the erosion of patient trust and subsequent disinclination to consent to treatment. Judicial notions of material risk are explored, and the conclusion reached that they offer a broader interpretation of disclosable risk compared to current UK GMC guidance. It is anticipated that empirical evidence could be used by the courts in determining questions of both materiality and causation in cases of negligent non-disclosure of potent financial interests. The paper concludes that there is sufficient reason to surmise that a test case could successfully apply the principles identified therein to establish the materiality of conflict of interest in informed consent to medical treatment. [ABSTRACT FROM AUTHOR]

Trans people experience high levels of depression, anxiety, and suicidal ideation and attempts, as well as poor experiences seeking mental health support. There is limited research into the experience and effectiveness of using Art Therapy with trans clients. This paper describes an Art Therapy group with trans clients. The group took place online due to the COVID-19 pandemic. Participants consented to have their images and experiences used in this practice paper. Building on the work of Beaumont (2012. Art therapy for gender variant individuals: A compassion oriented approach. Canadian Art Therapy Association Journal, 25(2), 1–6. https://doi.org/10.1080/08322473.2012.11415565), and using a neurobiological understanding of Art Therapy, this paper theorises that Art Therapy strategies known to be effective with trauma survivors may also support clients experiencing gender dysphoria. Considering Beaumont's model, a six-week online Art Therapy intervention using weekly focused themes was developed. A strong focus was given to creating group cohesion through co-creating a working alliance. Clients reflected together on artwork created through arts journaling between sessions. Participant engagement was high. The intervention received consistently positive solicited and unsolicited feedback from clients. Limitations of this feedback are noted. Trans clients reported that the use of an online arts journaling group approach facilitated a powerful sense of belonging created in the group and reflected through the artwork. Research is needed to consider Art Therapy's effectiveness in improving wellbeing for trans clients through creating a sense of belonging. Research could also consider whether clients experiencing gender dysphoria could be supported by Art Therapy approaches known to work well with traumatised clients. Trans clients are likely to need support with their mental health due to experiencing high rates of depression, anxiety, and suicidal feelings. They are also likely to describe poor experiences of seeking out mental health support. This highlights the importance of developing appropriate, supportive Art Therapy interventions with this client group. This paper describes a six-week online Art Therapy group with trans clients. The group took place in the context of a charity programme to support improved mental health and wellbeing in the trans community. Due to the COVID-19 pandemic, the group took place online. The group used an arts journaling approach. Clients made artwork between sessions, and shared and reflected on what they had created as a group over Zoom. I describe the theoretical approach which led to the creation of the group, noting the lack of research into working with this client base. I also outline the perspectives considered when recreating the intervention online due to the COVID-19 pandemic. I describe the group's online sessions. I show how the group worked together to create a strong working agreement and shared values. I explore participants' reflections on their artworks. I consider the emergence of a strong sense of belonging within the group. I also reflect on participants' feedback, giving space for clients' own words about their experience. Client feedback shows that participants value sharing their experiences with people they feel understand them and experiencing a sense of belonging in a supportive community. Further research is needed to explore the effectiveness of Art Therapy in improving mental health and wellbeing with this client group. Clients hoped that sharing their experiences could help enable an Art Therapy approach to be considered with trans clients in other contexts. [ABSTRACT FROM AUTHOR]

This commentary describes how a grassroot-led partnership initiated by members of the organisations World Federation of NeuroRehabilitation and Collaboration of Aphasia Trialists is addressing the marginalisation of people with aphasia, through education and knowledge exchange related to communication partner training of health professionals. A partnership between academics and healthcare professionals across Austria, Denmark, Egypt, Ireland, Greece, India, Serbia and the United Kingdom was established in 2020. Through bimonthly online sessions in 2021–2022 a Danish communication partner training program was introduced while six teams adapted and translated the training and its materials to their local contexts. A collaborative partnership enabled multiple translations of an existing communication partner training program for healthcare professionals working with people with aphasia to support a sustainable delivery model that is linguistic and culturally sensitive. This commentary paper focusses on Sustainable Development Goal (SDG) 17 and also addresses SDG 10. [ABSTRACT FROM AUTHOR]

University student mental health and wellbeing is a concern, exacerbated by the COVID-19 pandemic. Loneliness and social isolation are drivers of student mental health problems, amenable to intervention. Connecting People was developed and piloted in health and social care services to support people to enhance their social connections. This paper reports results of a pre-post, single-group evaluation of training provided to 105 people supporting students in a UK university, and the feasibility of using a Connecting People adaptation to reduce student social isolation. Trainee confidence in supporting socially isolated students increased after training and remained high six months post-training. Positive feedback included students making new friends, and helping trainees to break down tackling loneliness and social isolation into manageable steps. Further evaluation is required to test effectiveness, but the model appears feasible to use at minimal cost, and may offer a suitable model to alleviate student social isolation. [ABSTRACT FROM AUTHOR]

This paper reports a structured review of the service development and organisational (SDO) research literature focused on prisoners with mental disorders. A large number of databases were searched, using a combined free-text and thesaurus approach. Papers were included if they had been published since 1983, were written in English, and contained research findings. Commentaries or descriptions of local service innovation were excluded. In all, 103 papers were identified that met all criteria; these were divided into 13 categories (e.g. screening, 18 papers; professional roles, 13 papers). The paper concludes that there is a clear need to consider commissioning SDO research for offenders in England and Wales in a coherent programme. [ABSTRACT FROM AUTHOR]

The article presents evaluations of research related to the professional development of healthcare providers in Great Britain. The critic says that the article "The Training Service Continuum: Exploring the Training Service Balance of Senior House Officer Activities" was an interesting paper, however, it has flaws. In the article "Cross-Cultural Medicine," the critic states that it contains a number of resources. "Teaching Professionalism Artfully" used different media to teach professionalism.

This paper presents findings from a 6-month study of New Psychoactive Substance (NPS) use in Manchester, UK. Drawing on interviews with 53 NPS users and 31 stakeholders, the paper documents a notable shift in the drug using landscape. It highlights how the homeless community-traditionally associated with alcohol dependency and problematic intravenous heroin and/or crack cocaine use are now switching to smoking synthetic cannabinoid receptor agonists, while men who have sex with men (MSM) and engage in chemsex-who have traditionally been strongly associated with the recreational use of ecstasy and other stimulants are now developing problematic intravenous drug using habits. The paper goes on to discuss the implications of this shift for existing models of treatment service delivery. In particular, it outlines the necessity for treatment services to develop innovative engagement strategies, alongside clearer referral pathways and improved service integration. [ABSTRACT FROM AUTHOR]

There is increasing demand for a systems approach within national healthcare guidelines to provide a systematic and sustainable framework for improvements in patient safety. Supported by this is the growing body of evidence within Human Factors/Ergonomics (HFE) healthcare literature for the inclusion of this approach in health service design, provision and evaluation. This paper considers the current interpretation of this within UK healthcare systems and the dichotomy which exists in the challenge to implement a systems approach. Three case studies, from primary and secondary care, present a systems approach, offering a novel perspective of primary care and blood sampling. These provide practical illustrations of how HFE methods have been used in collaboration with healthcare staff to understand the system for the purpose of professional education, design and safety of clinical activities. The paper concludes with the challenge for implementation and proposes five roles for systems HFE to support patient safety. Practitioner Summary:healthcare is classified as a complex and dynamic system within this paper and as such HFE system methods are presented as desirable to understand the system, to develop HFE tools, to deliver education and integrate HFE within healthcare systems. [ABSTRACT FROM PUBLISHER]

The rising demand for health and social care, and around the clock monitoring services, is increasing and are unsustainable under current care provisions. Consequently, a safe and independent living environment is hard to achieve; yet the detection of sudden or worsening changes in a patient's condition is vital for early intervention. The use of smart technologies in primary care delivery is increasing significantly. However, substantial research gaps remain in non-invasive and cost effective monitoring technologies. The inability to learn the unique characteristics of patients and their conditions seriously limits the effectiveness of most current solutions. The smart metering infrastructure provides new possibilities for a variety of applications that are unachievable using the traditional energy grid. By 2020, UK energy suppliers will install 50 million smart meters, therefore, providing access to a highly accurate sensing network. Each smart meter records the electrical load for a given property at 30 minute intervals. This granular data captures detailed habits and routines through the occupant's interactions with electrical devices, enabling the detection and identification of alterations in behaviour. The research presented in this paper explores how this data could be used to achieve a safe living environment for people living with progressive neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the UK hospital supply chain in light of recent government policy reform where patients will have, inter alia, greater choice of hospital for elective surgery. Subsequently, the hospital system should become far more competitive with supply chains having to react to these changes as patient demand becomes less predictable. Using a qualitative case study methodology, hospital managers are interviewed on a range of issues. Views on the development of the hospital supply chain in different phases are derived, and are used to develop a map of the current hospital chain. The findings show hospital managers anticipating some significant changes to the hospital supply chain and its workings as Patient Choice expands. The research also maps the various aspects of the hospital supply chain as it moves through different operational phases and highlights underlying challenges and complexities. The hospital supply chain, as discussed and mapped in this research, is original work given there are no examples in the literature that provide holistic representations of hospital activity. At the end, specific recommendations are provided that will be of interest to service to managers, researchers, and policymakers. [ABSTRACT FROM AUTHOR]

The introduction of a market mechanism into the National Health service in the UK was underpinned by the belief that decentralised purchasing would both improve the quality of health care provision and restrain spiralling costs, through purchasers exercising their ability to choose between alternative providers. Focusing on budget holding General Practitioners, that is those practices responsible for purchasing hospital services for their practice populations, this paper explores the evolving purchasing behaviour of these professional intermediaries. Drawing on empirical evidence gathered as part of a broader study of the purchasing behaviour of GP Fundholders in Scotland, specifically it examines the key information sources and decisional criteria utilised by these professional intermediaries in selecting health care providers for their practice population. Utilising relational models of market behaviour, it addresses both the contextually specific issue of whether the market mechanism within the NHS is achieving the twin objectives of improving health care provision and restraining cost pressures, and the broader conceptual issue of the purchasing behaviour of professional intermediaries within a service sector environment. [ABSTRACT FROM AUTHOR]

Risk regulation analyses the organization and institutional settings for risk regulation and regulatory practice. This special issue focuses on risk regulation research with respect to two main areas of health care: infrastructure and service provisions and the risk regulation of critical areas relating to patient safety. This editorial draws out some of the main themes in risk regulation studies as they relate to these papers. Risk and governance issues consider which risks attract state regulatory responses and how risk debates connect with regulatory policy making. The emergence and reform of risk regulation and governance regimes is examined and varying perspectives offered on the status of experts, expertise and professionals in risk regulation. Many risk regulation initiatives are the result of public sector modernization programmes where the transferability of approaches and tools are taken for granted. How organizations respond to risk regimes and the extent to which organizations create their own risk regulation regimes thus become a clear focus in this volume. In medical situations, risk regulation may lead to resistance rather than openness and learning. The unintended consequences of risk regulation is an important theme: new financial frames of reference come into collision with other professional perspectives and performance data may be misinterpreted and misused. One strong message is that risk regulation in the UK is in a state of flux and that learning from crises and routine organizational data and experience are crucial in the resolution of the present difficult web of risk regulation initiatives. [ABSTRACT FROM AUTHOR]

A series of online practice development discussions were held during the Covid-19 pandemic by the Art Therapy and Learning Disability Professional Support Group of the British Association of Art Therapists (formerly known as the Special Interest Group). (1) To capture the experiences of art therapists living through and working with this population during the global pandemic; (2) To describe the barriers and facilitators for online art therapy with people with a learning disability. An anonymised, hand-written record was made during six 60-minute Zoom sessions. The data was transferred to an Excel database. Reflexive thematic analysis was conducted. The resultant themes and thematic map are shared in this paper. The themes are: (A) The pandemic as leveller. (B) The joy and jeopardy of working online. (C) Art after the eclipse. (D) The function of the professional support group. (E) Insight and understanding to meet client diversity. Stimulated by the national restrictions imposed due to the pandemic, art therapy practice changed at an unprecedented pace. Online art therapy for people with a learning disability may provide a viable alternative to face-to-face art therapy. The BAAT Professional Support Group provides an important peer-network for art therapists and could become a practice-based research hub. Further research is needed to develop best-practice online art therapy; this must include experts by experience as co-researchers. Additional training will be needed for art therapists to practice safely and confidently online. In 2020, the coronavirus made many people across the world sick, some people died. In the UK, our government asked us to stay at home to help to stop the virus spreading. Lots of things changed very suddenly – activities, hobbies and therapy were stopped. This meant that people with a learning disability were not able to keep coming to their art therapy sessions. Art therapists across the UK met on the internet, using a video-chat, to talk about what changes they had made in their clinical practice, whether they were able to keep therapy going during the pandemic and how they felt about the changes. We wanted to understand: (1) Art therapists' experiences during the pandemic. (2) What's helped and what's gotten in the way when art therapists have worked online with people with a learning disability. This piece of research uses a qualitative research procedure called 'thematic analysis' to make sense of different people's views. Thematic analysis is a systematic way of organising and interpreting large volumes of information, called 'data'. In this research, the data is people's words, which were written down live during the six video-chat meetings. Using thematic analysis helps us to find patterns in the data where people have a similar or different view. These patterns are called: 'themes'. The themes gave us a concise record of a broad range of people's views. We found five key themes: (A) The pandemic as leveller. (B) The joy and jeopardy of working online. (C) Art after the eclipse. (D) The function of the professional support group. (E) Insight and understanding to meet client diversity. Online art therapy might help some people with a learning disability, but we need more research and training. Art therapists value peer-support. Our peer-support group could help to develop more robust research projects. [ABSTRACT FROM AUTHOR]

The scarcity of public sector healthcare resources and the vulnerability of service users make the conduct of health professionals critically important. Health regulators, in delivering their core objective of patient protection, use empirical evidence to identify professionals' misconduct, improve their understanding of why misconduct occurs, and to maximize the effectiveness of regulatory actions that safeguard public trust in the healthcare system. This paper outlines the contribution of comparative academic analysis of three professions in the UK (doctors, nurses & midwives, and allied health professions) based on 6714 individual cases of professional misconduct. Three dynamic strands of ongoing impact are identified: "dialogue", that creates an international multi-stakeholder community of interest; "knowledge generation", which advances conceptual and empirical understanding of counterproductive work behaviour through sequential quantitative and qualitative study; and "dissemination", where practical learning is utilized by regulators, employers and other academics. [ABSTRACT FROM AUTHOR]

Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor. [ABSTRACT FROM AUTHOR]

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Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA. [ABSTRACT FROM AUTHOR]

In this paper, we argue that there is much that we can learn from the past as we explore the issues raised when designing innovative social media and mobile technologies for learning. Like the social networking that took place in coffee houses in the 1600s, the Internet-enabled social networks of today stand accused of being the so-called “weapons of mass distraction” or worse. However, we point out that modern fears about the dangers of social networking are overdone. The paper goes on to present some of the 1930s ideas of Vygotsky. Part of the Learning Layers project builds on this work; we report on extensive initial co-design work and significant barriers with respect to the design of a mobile Help Seeking tool for the health care sector (UK). We then provide an account of how the Help-Seeking tool is being linked to a Social Semantic Server and briefly report on a follow-up empirical co-design study. We conclude by highlighting associated challenges. [ABSTRACT FROM PUBLISHER]

This paper offers a case study of a large UK local authority adult care department as it introduces a new practice model. The change programme is examined through a lens of complexity theory. Complexity offers a way of understanding constantly changing systems and uses concepts such as 'feedback loops' and recognition of 'emergent' behaviours to offer a means to anticipate patterns of change in otherwise unpredictable systems. In this study, complexity is found to offer a helpful understanding of behaviour across the complex adaptive system of a large organisation but it falls short at recognising the cause of behaviours that can be obstructive. The author suggests the use of psychoanalytic theory to acknowledge the emotion that might be the driver for resistance to change and notices how effectively the two theories applied together can bring rich understanding as well as strategic oversight to a complex social care system. This study provides a useful, theoretically informed insight into change management and leadership within a social work agency that is moving away from transactional practice and promoting creative, autonomous, relationship-based practice. The study advances understanding of how complexity and psychoanalytic theory can be used in tangent to support organisational change within social care. [ABSTRACT FROM AUTHOR]

This paper presents findings from a UK mixed-method study that aimed to understand parents/carers' views and experiences of support received from health services for primary school age (4–11) gender diverse children and their families. Data was collected via an e-survey including 10 open-ended questions with 75 parents/carers addressing experiences with (i) primary health services, including general practice (GP) clinics and child and adolescent mental health services (CAMHS) (ii) specialist gender identity development services (GIDS) (iii) non-health related support including transgender groups and online resources. Findings are organised into four themes: 'journey to health service provision', 'view on health services used', 'waiting' and 'isolation'. Discourses about gender diversity, childhood and the validity of trans healthcare shape parental experiences, including their desire for better information, more certainty in healthcare pathways and more expedient access to support services to reduce anxiety, distress and isolation. The emotional costs of waiting are compounded by the material costs of accessing the limited number of specialist services. Experiences could be improved through ensuring GPs and CAMHS are better prepared, expanding access to trans-specific support groups for those caring for children and young people, and exploring the provision of school-based support for gender diverse primary-age children. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to demonstrate how QFD can enhance a healthcare organisation's strategic operational alignment, by synchronising the infrastructure design with the service intention. In this empirical paper, a case study of a £15 million infrastructure development has been used as the unique context to assess and test the experimental findings. QFD was utilised in order to capture and transform the requirements of decision-makers, providers, patients and local communities into both service and building design for Project K, a healthcare infrastructure, in the U.K. Two full iterations of the QFD results are presented. Using QFD generated effectiveness and efficiency by creating an information exchange platform and providing the stakeholders with a framework to optimise the decision-making. This paper makes a practical contribution by empirically testing the QFD modelling and providing evidence of its implementation within the complex, dynamic and evolving nature of the healthcare built environment sector. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

This paper explores the theoretical Islamic legal framework and methodology used by Islamic religo-legal authorities (singular muftī) in issuing rulings (singular fatwa) regarding contemporary medico-ethical issues of concern to Muslim minorities, health professionals and policy-makers in Britain. It demonstrates that the guiding principle used by Islamic religo-legal authorities related to medico-ethical issues in Britain is the Quranic precept of “Enjoin the good, prevent the harmful.” In particular, the Islamic legal instrument of maṣlaḥa (public interest) is used to arrive at rulings in a process in which the role of the muftī is crucial. It is shown that the muftī can legitimately function in a contemporary liberal society such as Britain because of the private nature of his authority that has historically been vested in this position. The paper also explores how the operation of the sharīʿa in Britain may potentially intersect with the British legal system and some of the consequences that arise from this potentiality. The paper concludes by reflecting upon what the issues raised indicate for the broader themes related to the integration of Muslims into contemporary liberal societies. [ABSTRACT FROM AUTHOR]

The application of concepts, theories and methods from systems ergonomics within patient safety has proved to be an expanding area of research and application in the last decade. This paper aims to take a step back and examine what types of research have been conducted so far and use the results to suggest new ways forward. An analysis of a selection of the patient safety literature suggests that research has so far focused on human error, frameworks for safety and risk and incident reporting. The majority of studies have addressed system concerns at an individual level of analysis with only a few analysing systems across multiple system boundaries. Based on the findings, it is argued that future research needs to move away from a concentration on errors and towards an examination of the connections between systems levels. Examples of how this could be achieved are described in the paper. The outcomes from the review of the systems approach within patient safety provide practitioners and researchers within health care (e.g. the UK National Health Service) with a picture of what types of research are currently being investigated, gaps in understanding and possible future ways forward. [ABSTRACT FROM AUTHOR]

Symptoms of depression are common in adolescents and have negative impacts on academic engagement and achievement, as well as on future mental health and functioning. A number of psychological therapies are effective for the treatment of adolescent depression but there are barriers to young people accessing treatment promptly. Providing treatment in school may help improve access to mental health care; school-based mental health care is routinely provided in some parts of the world and is currently a policy priority in the UK. However, introducing mental health services into schools will require services to adapt. This paper illustrates how a short-term psychological therapy can be delivered successfully in schools. It describes the treatment and outcomes for two young people with symptoms of depression. Both received Brief Behavioural Activation (Brief BA) which has been adapted specifically for adolescents. Brief BA focuses on helping young people engage with valued activities in different areas of their life, thus increasing rewards and reducing symptoms of depression. The two cases highlight a range of educational and clinical benefits of Brief BA for young people with depression symptoms and illustrate how the treatment and service delivery were adapted for schools. [ABSTRACT FROM AUTHOR]

This paper seeks to improve our understanding of the emotional and political dynamics that are generated (and too often avoided) in action learning. The idea at the centre of the paper is a distinction between 'learning-in-action' and 'learning inaction'. The phrase 'learning-in-action' represents the value of action learning and much of what we know about the productive relationship between learning and practice. For example, we know that action learning can provide a generative learning model for improvements in practice. Membership of an action learning set can assist individuals in the development of strategic actions, which then can be tested and potentially transformed in practice. However, there is another dynamic that is having an effect on learning and the transformation of practice within action learning. This is called 'learning inaction' because participants in learning sets also have (conscious and unconscious) knowledge, fantasies and perceptions about when it is emotionally and politically expedient to refrain from action, when to avoid collective action, and the organizational dynamics that underpin a failure to act. Organizational members are often aware of the political limits of learning within organizations without having to be told; we collude with others in order to create limitations on learning and we are often aware of what is and is not going to be seen as a legitimate result of our attempts to learn. We know these things at the same time as we are engaged in action learning. These developments in theory are related to practice through a focus on four action learning sets within the UK Health Service. [ABSTRACT FROM AUTHOR]

Addressing inequalities in health has featured strongly in UK health care policy over recent years, and efforts to consider inequalities at 'ground level' are increasingly evident. This includes enhancing primary care and other community-based services and emphasising consultation at community levels. The Healthy Living Approach to community development in Pembrokeshire, West Wales, was initiated and evaluated as part of the Welsh Assembly Government's Sustainable Health Action Research Programme (SHARP). As part of that programme an action research project was organised to respond to a context of funding and service delivery coloured by rural isolation, social exclusion and poor health. The project was adopted in three marginal communities and was evaluated using multiple methods to understand the effects of the initiative and how well it was seen to have worked. This paper reports on one aspect of that evaluation: focus groups with Project Steering Group members that examined the impact of the intervention from the perspective of those involved in the study's implementation. The paper highlights the perceived impact on community members and study organisers, the process of liaison between community and statutory body advisers and the appropriateness of the methodology. There was overwhelming support for the project and agreement that action research was the only feasible working methodology. The results offer insider views on the potential for 'healthy living' community interventions to enable communities to engage with locally defined health issues, but sets a note of caution about being able to achieve real and sustainable change. [ABSTRACT FROM AUTHOR]

This paper outlines the way in which professional self regulation of quality of healthcare was integral to the creation of the National Health Service (NHS) in 1948, and to the way the NHS was organized for the next 50 years. It describes the crisis in quality that emerged in the late 1990s. It describes the government's initial responses to that crisis, which were to require NHS organizations to implement systems of clinical governance, and create the Commission for Health Improvement (CHI) to inspect its implementation through visits to each NHS organization. The paper discusses Reports from Inquiries into three scandals, and considers the further changes made to governance and regulation of quality with the abolition of CHI and the National Care Standards Commission, which inspected the private sector, to be succeeded by the Healthcare Commission with a new approach to regulation. It examines three promises of that new approach: the use of national standards; being 'light touch' and proportionate using 'intelligent' (or 'smart') information, as opposed to being organized on a comprehensive programme of visits; and developing a common approach to the NHS and private sectors. [ABSTRACT FROM AUTHOR]

Background: This paper is concerned with the issue of service user involvement in education and training within psychological therapy training within the UK. Aims: In particular this paper reflects on the literature on user involvement to gain a deep understanding of its status in the education and training of psychological therapists. Method: A systematic search of the literature indicates minimal involvement from service users in the education and training of psychological therapists. Results: The possible reasons for this are discussed, along with what service users might want from such involvement, what it might add to psychological therapies training, the models of involvement that might be adopted, how service users may be recruited and how they may be involved in the various stages of the educational process, from commissioning, through delivery, to evaluation of programmes. Conclusion: If service user involvement in psychological therapy training is carefully planned, supported and evaluated, it could improve the trainees' practice, so that it reflected the priorities and wishes of those receiving the service. Nevertheless, it is currently an underdeveloped area within contemporary psychological educational practice. Declaration of interests: None. [ABSTRACT FROM AUTHOR]

One of the principle tenets of action learning is that it provides the potential to explore and solve complex organisational problems. The question of how best to develop a future business strategy is such a problem. Existing literature on strategy making presents a multi-faceted debate, suggesting that the complexity of competitive environments means that the strategic route forward for many organisations can often be unclear. As a lecturer who teaches strategy at university, I have been intrigued by the ‘Learning Group’ of strategy making (Argyris & Schon, 1974; Quinn, 1980; Mintzberg, 1987; Argyris, 1993, 2004) for some time, as it argues that competitive environments are complex and unpredictable, and therefore, organisational strategies must be reactive and flexible. As a consequence, strategies simply emerge over time, and are characterised by a process of trial and error where individuals and groups within the organisation learn more about the environment they are competing in and how best to take advantage of it. This paper aims to explore two key questions: firstly, to examine the role that action learning could play in helping strategy makers become more reflective practitioners, and secondly, to explore the use of peer consultancy as a vehicle to enable action learning. This paper presents the findings of empirical research from an action learning project with the Chief Executive of a leading UK service provider of health and fitness. It provides a detailed examination of how a service management strategy was developed in practice and enabled by a process of iterative action, change, reflection and learning. [ABSTRACT FROM AUTHOR]

This paper presents a critique of research approaches used in health and social care research with vulnerable and socially disadvantaged groups, and children and young people from minority ethnic backgrounds in Britain. The paper aims to critically examine research processes in health and social care from a psychological perspective and a social work perspective. This paper argues that a conceptual framework that incorporates a cross-cultural perspective for understanding the development of minority ethnic children is critical in order to address omissions in existing theoretical formulations and research in social work and health care theory and research. In the United Kingdom there is a lack of social work research from a cross-cultural perspective. Research knowledge and information from a cross-cultural perspective on minority ethnic family life, minority ethnic children and young people are vital to the health care and social work profession. [ABSTRACT FROM AUTHOR]

The following is a full account of a paper presented at the conference 'Think Global Act Local' held on 29 November 2002 to mark the launch by the four Health and Social Services Boards of the Children's Services Plans 2002-2005. In this paper, I provide a voluntary sector perspective on the changes in the past 3 years in the process of children's services planning, the unique contribution this planning process has to make and the challenges ahead. [ABSTRACT FROM AUTHOR]

This paper considers the institutional factors that shape regulatory officials' perceptions of risks to human health and safety and their attitudes towards associated regulation. In particular, the paper considers the extent to which the perceptions of risk and regulation of officials responsible for monitoring and enforcement are aligned with regulatory requirements, and, if not, what factors explain those perceptions. Moreover, the paper considers the impact of officials' perceptions and attitudes on policy processes and outcomes. Empirically, the paper considers three UK risk regulation regimes: occupational exposure to radon, chemical migration from plastics food packaging and BSE related controls on specified bovine offal. Analysis of those cases suggests that conventional accounts that contrast ‘rational’ bureaucratic expertise against ‘irrational’ lay perspectives can miss the institutional ‘irrationalities’ that shape officials' perceptions of risk and associated behaviour. In particular, the paper suggests that complex risk regulation regimes are vulnerable to a phenomenon of ‘institutional attenuation’. That term refers to institutional processes that serve to diminish inspectors' perceptions or awareness of a risk, and/or diminish inspectors' perceptions of the policy importance of associated regulations. Furthermore, the paper shows how such institutional attenuation can contribute to ineffective monitoring and enforcement of some risk regulation regimes. [ABSTRACT FROM AUTHOR]

This paper presents findings from a study that investigated the relationship between research and practwice on a Nursing Development Unit (NDU) in a hospital in the UK. The over-arching aim of the NDU was to promote individualised patient care. This requires the experiences and life goals of the patient, including the patient's and family construction of risk, to inform the care planning process. Two projects, undertaken by nurses on the ward, one on inpatient self-medication and the other on the management of falls, are analysed as case studies in order to address the questions: (1) How do nurses develop and research patient-centred care? (2) What are the implications of their choice of methodology in relation to their stated aims of individualising care? The paper demonstrates how conventions about research methodology and outcomes dominated the nurses' interpretation of research, the hospital research agenda and the literature on the research topics. These conventions shaped the construction of risk and safety within the hospital setting compromising practice developments designed to support the implementation of individualised care processes. [ABSTRACT FROM AUTHOR]

The paper presents an assessment and evaluation of what is termed 'new public management' at the end of the 1990s. In order to provide this assessment, new public management is defined in several ways: as a movement, as an academic commentary, and as reformed organizational practice in the public sector. The paper uses the UK health sector to examine some of the assumed relation-ships between ideology, actions and consequences implied within a broad understanding of new public management. Developments in the UK health sector are used to address assumptions focusing on different aspects of the ideology (private sector practices and markets can increase efficiency in the public sector), actions (introduction of market mechanisms and business-like practices) and consequences (operational performance, strategic direction, governance and values). Drawing on developments in the UK health sector, an assessment of new public management at the end of the 1990s sees it much diversified and expanded from original conceptions, which are ensuring its contested survival as a movement, as an academic commentary, and as reformed organizational practice in the UK despite a change of government in 1997. [ABSTRACT FROM AUTHOR]

Stakeholder engagement plays a fundamental role in the success of 'operational research' initiatives including simulation projects. However, there is little empirical evidence of real engagement in the context of healthcare simulation. This paper principally examines this issue and aims to provide insights into the possible causes. The paper reports on the results of a literature review and 10 field studies within the UK healthcare settings, supplemented with the authors' experience in order to arrive at an initial list of the causes, which will then be tested through a survey of expert opinions. Twelve primary and 26 secondary causal factors, which received statistically significant level of agreement from the experts, are presented in a fish-bone diagram. The findings indicate that communication gap between simulation and stakeholder groups is the top primary factor contributing the most to the poor stakeholder engagement in healthcare simulation projects, followed by 'poor management support', 'clinician's high workload' and 'failure in producing tangible and quick results'. [ABSTRACT FROM AUTHOR]

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This paper reports the results of a research project into the determinants of consumer evaluation of services. The research uses the healthcare context to explore consumer perceptions of the service product dimensions. Using a critical incident technique, a consumer-derived model of the relationships between core and peripheral aspects of the service is presented. The results indicate that evaluation is a function of both personal and organizational factors which comprise core and peripheral components of the service. [ABSTRACT FROM AUTHOR]

In the last few years there have been considerable changes in the National Health Service. Perhaps the most significant of these has been the introduction of competition into health care, that is the split of the health service into purchasers and providers of care. Central to this development has been the introduction of general practice fundholding, whereby practices are able to purchase health care for their patients directly from competing suppliers. Those practices which have become fundholders have faced considerable challenges in developing their purchasing function. At the same time, provider units in areas where fundholding has become established face an increasingly fragmented purchasing base. Building on existing theoretical work into the nature of organizational purchasing behaviour and current knowledge of the health care market in Britain, this paper attempts to develop an understanding of the dynamics of GP fundholder purchasing behaviour. [ABSTRACT FROM AUTHOR]

Healthcare in Britain from the sixteenth century through to the mid-nineteenth century has been characterised as a medical marketplace, a model that emphasises plurality, diversity, competition, and consumer choice. The medical marketplace was an unregulated space, in which qualified doctors were forced to compete with chemists and druggists, medicine vendors and quacks; one in which the gullible consumer was acutely vulnerable to unscrupulous suppliers. However, many details regarding the complexion of the medical marketplace and the timeframe and circumstances of its demise are unclear. This paper discusses the findings of a comprehensive survey of healthcare provision in Gloucester circa 1850, utilising a wide range of sources, some of which have been overlooked in previous studies. Focussing on the key attributes of the medical marketplace: plurality, diversity, choice and competition, it will suggest that the idea that the medical marketplace came to an end around the 1850s as the result of the professionalization of medicine is not supported by the evidence. In Gloucester, the transition to a more structured and stratified healthcare economy, dominated by the medical profession had occurred at an earlier date and by the 1840s was already largely complete. [ABSTRACT FROM AUTHOR]

The World Health Organization’s Ottawa Charter for Health Promotion has been considered a seminal document and template for health promotion since its inception and is still seen as a “gold standard” for health promoters worldwide who wish to improve health and reduce inequalities. Although its principles have been widely applauded, opportunities to transfer these principles into the radical changes and practical solutions needed globally to improve health have been missed. This paper examines how the Charter has influenced United Kingdom health care policies by examining two of the Charter’s key strategies, creating healthy environments and reorientating health services. In the UK, currently, there remains an over emphasis on personal responsibility and behaviour change, rather than tackling fundamental societal-wide issues. Nevertheless, it is argued that the Ottawa Charter retains its relevance to the present day and that all policy makers and professionals working to promote positive health should revisit and take heed of its principles. [ABSTRACT FROM AUTHOR]

The value of a new evidence-based design approach to healthcare architecture is described and the range of evidence available introduced. The paper then focuses on the challenge of applying empirical research knowledge to a creative design process. Examples are given of the results of such an approach and of how we can develop design tools to transfer complex scientific knowledge into a “designerly way of knowing”. [ABSTRACT FROM AUTHOR]

Recent UK Government reform of the National Health Service (NHS) has specifically targeted allied health professionals. As key members of the NHS work force, they have the capacity to modernize health service delivery. One way of enabling these professionals to fulfil the modernization agenda is through the development of their knowledge and skills. A recent document produced by the sector skills council for health care, “Skills for Health”, proposes a competency-based career framework for allied health professionals detailing the knowledge and skills they will need to develop for their future roles in the NHS. This paper briefly outlines the broader context in which professions in the UK have experienced the process of state-led reform over recent years. In particular, it identifies the motivation for the development of a skills-based workforce for the NHS and develops a critique of the economic and ideological rationales for the emergence of a competency-based career framework. Particular attention is paid to how such planned changes may affect professionalism and the professional roles for those working in the professions allied to medicine. [ABSTRACT FROM AUTHOR]

In the UK, new intermediate care services have been established to prevent unnecessary hospital admissions, facilitate effective discharge and prevent premature care home admissions. This paper reports findings from a national evaluation of intermediate care, focusing on the relationship between hospital services and intermediate care. Participants included key managers and practitioners involved in the planning, management and delivery of intermediate care in five case study sites. During the study, they identified a range of tensions between hospital services and intermediate care, including concerns about the role and involvement of acute clinicians; the safety, quality and appropriateness of intermediate care; access to and eligibility for intermediate care; a lack of understanding and awareness of intermediate care; and the risk of intermediate care being dominated by acute pressures. Although participants were able to identify several practical ways forward, resolving such fundamental tensions seems to require significant and long-term cultural change in the relationship between acute and intermediate care. Overall, this study raises questions about the extent to which intermediate care will be able to rebalance the current health and social care system and make a substantial contribution to tackling ongoing concerns about emergency hospital admissions and delayed transfers of care. [ABSTRACT FROM AUTHOR]

The delivery and content of interprofessional education (IPE) varies greatly. Currently there is little evidence to suggest the most effective approach. This paper describes an interprofessional learning programme offered to second year healthcare students (IPL2), which was developed together with the students. At the outset of developing IPL2, an interprofessional student planning group (supported by a facilitator) was formed. The student planning group (SPG) reported back their ideas to an IPL steering group. Student feedback forms from 2005-2006 were used for the review and further development of IPL2. Analysis of student feedback was completed using median (for the quantitative elements of the form) and content analysis (for the qualitative elements). Post-programme student feedback included suggestions such as improvements to the case scenario, issues such as the logistical problems associated with students being on placement and how to overcome this by expanding the use of a virtual learning environment. Student views have informed both the original and ongoing development of IPL2 and ensure that the IPL programme remains relevant to the students. This model of involving students in the development of IPL has proven effective and can be applied to other settings. [ABSTRACT FROM AUTHOR]

Over the past 30 years, the important role of primary care in public health has been widely recognised, and in the UK a range of measures to support public health in general practice have been introduced since the late 1980s. In 2004 a new general medical services contract was introduced changing the way general practitioners are reimbursed in the NHS. The new contract shifted the emphasis from the individual practitioner to the practice and introduced a new performance incentive framework, the Quality Outcomes Framework, which rewards performance through targeted financial payments. The performance framework identifies specific areas of clinical and organisational performance and patient experience activities-including a number of health promotion activities-and practices attract points for attaining performance targets. This paper examines the experience and impact of the new GMS contract on public health activities in general practice. While the contract has only been operating for three full years, there is emerging evidence to suggest that it may have a negative impact on public health activities in general practice. The use of financial incentives appears to be skewing practice towards areas that are rewarded, which may not be those that maximise health outcomes, and there is some emerging evidence suggesting that there is a negative effect on health inequalities. This paper reviews current evidence on public health incentives in general practice within a wider context of the impact of incentives for public health. [ABSTRACT FROM AUTHOR]

The role of the independent sector in the provision of clinical services on behalf of the NHS in England is often misunderstood and is perceived by some stakeholders as offering the NHS little more than marginal additional capacity. Indeed, some NHS organisations have been accused of 'obstructive, disruptive and protectionist behaviours' towards non-traditional 'NHS family' service providers. This paper outlines the development of the independent sector's role in the provision of clinical healthcare services over recent years. The first part of the paper considers the historical context, including the impact of both the changing role of the state over the past 50 years and the change of government at the end of the last century. Consideration is then given as to the position today, and the impact of current policy drivers for the use of the independent sector in the provision of NHS clinical services. The final part of the paper uses the specialty of orthopaedics, for the purposes of illustration, in order to explore the contribution of the independent sector to the delivery of the last remaining major access target, 18 weeks referral to treatment, and the development of a range of responsive services in the community. [ABSTRACT FROM AUTHOR]