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People with learning disabilities are living longer. Older people with learning disabilities should be included in policies and plans that are for all older people. National plans and policies for older people often do not say anything about older people with learning disabilities, and it is hard to know whether older people with learning disabilities are benefiting. People who plan services locally often do not have good information on older people with learning disabilities. Using the Equalities Act 2010 could help people who plan services and write policy to think about older people with learning disabilities but this is not happening at the moment. People who work with older people with learning disabilities should be aware of policy for all older people, so that older people with learning disabilities do not miss out. This paper seeks to explore the opportunities and challenges generated by current policy, guidance and legislation in England relating to older people, in terms of the practical implications for older people with learning disabilities. Using the broad themes housing, employment, social inclusion and isolation, care and support, and promoting better health and well-being, this paper discusses potential practical opportunities and concerns for older people with learning disabilities arising from policy and legislation such as current initiatives regarding integration, personalisation and the dementia policy. Consideration is given to the implications of changing policy and practice for both current and future generations of people with a learning disability as they reach older age. This discussion paper concludes that whilst there is potential for older people with a learning disability to benefit from policy and practice aimed at improving the lives of older people generally, the tendency for policy to be targeted at specific groups without adequately considering the diversity of those groups often leaves those with a learning disability at the margins of being able to make the most of changes. [ABSTRACT FROM AUTHOR]

This paper examines the impact of major social security reform on mental health claimants by analysing the transition to Personal Independence Payment in the UK. Personal Independence Payment was introduced in April 2013, replacing Disability Living Allowance as the main non-means tested disability benefit intended to assist with the additional costs associated with disability or long-term health conditions. It is important to gain a better understanding of how people with mental health problems have experienced this reform. Twelve service users were interviewed for this qualitative research. Analysis identified three main themes: problems with the Personal Independence Payment claims process; problems conveying mental health problems during the assessment process; and positive experiences associated with the transition to Personal Independence Payment. This research demonstrates that major changes in benefit policy are challenging for people with mental health problems, particularly when delivered in a climate of austerity. The UK Government has changed the main disability benefit for disabled adults. From April 2013, Disability Living Allowance (DLA) has been phased out and replaced by Personal Independence Payment (PIP). This research found that this significant change caused difficulties for people with mental health problems. Everyone who took part reported increased anxiety, problems with claiming PIP, communicating with benefit officials and the medical assessment. It is important to learn from these problems so that future benefit changes, both in the UK and in other countries, can be developed and rolled-out in ways which are more appropriate for people with mental health problems. [ABSTRACT FROM AUTHOR]

The veterinary profession has been at the forefront of ensuring that health planning is now widely adopted in the farm animal sector; however, health planning is not widely undertaken in the goat sector. This may in part be due to the relatively small number of goats kept in the UK, but also to the wide variety of reasons for which goats are kept, from commercial dairy herds to hobby purposes. This article describes the areas that should be considered when constructing a health plan for goats. [ABSTRACT FROM AUTHOR]

The UK National Health Service (NHS) employs a group of 14 separate allied health professions. Prosthetics and orthotics are the smallest of these professions. Although small, orthotics is integral to many clinical care pathways and has shown to provide an essential impact on a range of clinical conditions in the health service priority lists. Previous reports acknowledged the lack of data on the UK prosthetic and orthotic workforce, appointment outcomes and cost and the service users accessing such services and thus the challenges that it poses for effective service delivery. There is still a paucity of relevant data or initiatives to support the service provision. The work within this paper has taken the first step to address this gap, presenting a summary of the information relating to appointments and costs, and provides a discussion on the implications of variations across the NHS orthotic services within England in terms of spend, staffing and skill mix for orthotic services and service users and the need for further data on service users and the UK prosthetic and orthotic workforce. [ABSTRACT FROM AUTHOR]

Many migrant groups, particularly those that are politically and economically marginalised, such as asylum seekers and refugees (ASRs), face inequities in access to health care as well as poorer physical and mental health outcomes. The role of post-arrival experiences in contributing to these inequities is increasingly being explored, and it is suggested that being a migrant is itself a determinant of health outcomes. Drawing on the theoretical concept of structural vulnerability, this paper explores ASRs' experiences of health, wellbeing, and health practices in the context of their lived realities in Scotland. 24 semi-structured interviews were conducted with ASRs from Sub-Saharan Africa between January and December 2015. Data were explored using thematic analysis. Experience of the UK asylum system, both alone and in conjunction with other sources of vulnerability including racism, poverty, and language barriers had a negative and ongoing impact on the physical and mental health of ASRs. These impacts continued, even once refugee status was obtained. Efforts to engage ASRs in preventive health programmes and practices must take into account the ways in which the asylum system acts as a determinant of health, affecting both what it means to be healthy and what capacity individuals have to engage with their health. Political choices in how the asylum process is enacted have far-reaching implications for individual and population health. [ABSTRACT FROM AUTHOR]

This commentary discusses the implications of the changes made to the social security system by the UK government in response to the COVID-19 pandemic. Until the COVID-19 pandemic, the UK government did not veer from its programme of welfare reform. However, emergency legislation made significant concessions including: an increase in the value of the UK's main means-tested benefit Universal Credit, more favourable eligibility rules for the self-employed, a reduced conditionality regime, and an increase in the level of housing support. This paper argues that although the UK government's COVID-19 social security response was necessary, it did not go far enough. A temporary lifting of some prejudicial elements of the social security system was welcome but this still leaves an overly complex system characterised by unacceptable delays in payment, inadequate support for many vulnerable groups, and inconsistent experiences for recipients of different benefits. [ABSTRACT FROM AUTHOR]

Abstract Small area health data are not always available on a consistent and robust routine basis across nations, necessitating the employment of small area estimation methods to generate local-scale data or the use of proxy measures. Geodemographic indicators are widely marketed as a potential proxy for many health indicators. This paper tests the extent to which the inclusion of geodemographic indicators in small area estimation methodology can enhance small area estimates of limiting long-term illness (LLTI). The paper contributes to international debates on small area estimation methodologies in health research and the relevance of geodemographic indicators to the identification of health care needs. We employ a multilevel methodology to estimate small area LLTI prevalence in England, Scotland and Wales. The estimates were created with a standard geographically-based model and with a cross-classified model of individuals nested separately in both spatial groupings and non-spatial geodemographic clusters. LLTI prevalence was estimated as a function of age, sex and deprivation. Estimates from the cross-classified model additionally incorporated residuals relating to the geodemographic classification. Both sets of estimates were compared against direct estimates from the 2011 Census. Geodemographic clusters remain relevant to understanding LLTI even after controlling for age, sex and deprivation. Incorporating a geodemographic indicator significantly improves concordance between the small area estimates and the Census. Small area estimates are however consistently below the equivalent Census measures, with the LLTI prevalence in urban areas characterised as 'blue collar' and 'struggling families' being markedly lower. We conclude that the inclusion of a geodemographic indicator in small area estimation can improve estimate quality and enhance understanding of health inequalities. We recommend the inclusion of geodemographic indicators in public releases of survey data to facilitate better small area estimation but caution against assumptions that geodemographic indicators can, on their own, provide a proxy measure of health status. Highlights • A novel cross-classified extension to small area estimation methodology. • Small area estimation of health indicators can be enhanced by geodemographic data. • Geodemographics and deprivation independently impact small area health estimates. • Deprived urban communities have much worse health than expected. [ABSTRACT FROM AUTHOR]

Small area health data are not always available on a consistent and robust routine basis across nations, necessitating the employment of small area estimation methods to generate local-scale data or the use of proxy measures. Geodemographic indicators are widely marketed as a potential proxy for many health indicators. This paper tests the extent to which the inclusion of geodemographic indicators in small area estimation methodology can enhance small area estimates of limiting long-term illness (LLTI). The paper contributes to international debates on small area estimation methodologies in health research and the relevance of geodemographic indicators to the identification of health care needs. We employ a multilevel methodology to estimate small area LLTI prevalence in England, Scotland and Wales. The estimates were created with a standard geographically-based model and with a cross-classified model of individuals nested separately in both spatial groupings and non-spatial geodemographic clusters. LLTI prevalence was estimated as a function of age, sex and deprivation. Estimates from the cross-classified model additionally incorporated residuals relating to the geodemographic classification. Both sets of estimates were compared against direct estimates from the 2011 Census. Geodemographic clusters remain relevant to understanding LLTI even after controlling for age, sex and deprivation. Incorporating a geodemographic indicator significantly improves concordance between the small area estimates and the Census. Small area estimates are however consistently below the equivalent Census measures, with the LLTI prevalence in urban areas characterised as 'blue collar' and 'struggling families' being markedly lower. We conclude that the inclusion of a geodemographic indicator in small area estimation can improve estimate quality and enhance understanding of health inequalities. We recommend the inclusion of geodemographic indicators in public releases of survey data to facilitate better small area estimation but caution against assumptions that geodemographic indicators can, on their own, provide a proxy measure of health status. • A novel cross-classified extension to small area estimation methodology. • Small area estimation of health indicators can be enhanced by geodemographic data. • Geodemographics and deprivation independently impact small area health estimates. • Deprived urban communities have much worse health than expected. [ABSTRACT FROM AUTHOR]

Purpose Professional partnerships between housing and health are not impossible, but they take time, commitment and dedicated strategic leadership. The language and culture of the two sectors are sometimes complex and do not always match. There can be issues understanding each other's motivation, ethics and terminology which can cause a barrier when working together. The purpose of this paper is to share the journey of how Wakefield District Housing (WDH) is working with the care and health sector to create sustainable partnerships that benefit both parties, getting to a stage where they could successfully integrate with healthcare providers in the Wakefield district.Design/methodology/approach The paper offers the reader an overview of how WDH's membership of the Wakefield Health and Wellbeing Board enabled improved partnership working with NHS and other members, including the establishment of a Housing, Health and Social Care Partnership, the employment of dedicated senior staff, co-located multi-disciplinary teams and joint design of new services.Findings WDH has demonstrated that the organisation understands the challenges facing NHS colleagues, has acknowledged the complexities of the system that their partners work in and looked for solutions alongside them. The opportunities within partnership working are boundless and, if successful, the outcomes for tenants and the wider Wakefield population could be in excess of those envisaged in planning the project. Partnerships will almost inevitably encounter challenges along the way but if all partners keep their own and shared visions in mind, further success is within reach and all parties will get there faster by not going alone.Practical implications The paper offers useful guidance and ideas for other housing organisations aiming to improve their contribution to local integrated healthcare.Originality/value This paper provides an original perspective from inside the programme, offering practical, comprehensive and deliverable initiatives to improve health outcomes for local communities. [ABSTRACT FROM AUTHOR]

In this brief paper, I argue that the coronavirus pandemic is functioning like an ethnomethodological 'breaching experiment'. In short, it is putting a gigantic spanner in the works of neoliberal governance, in the process exposing the widening cracks and fissures of what I have called the 'fractured society'. I begin by recalling Garfinkel's notion of the breaching experiment and by listing the principal attributes of the fractured society. I then explore the response to the coronavirus in the UK, from the government's initial commitment to 'herd immunity' to its present policy of 'muddling through'. The bulk of the remainder of this contribution addresses precisely how this global health crisis shines a harsh and unforgiving searchlight on the strategies and policies pursued by governments in the UK since 2010, and most especially after the passing of the Health and Social Care Act of 2012. In the closing paragraphs, I examine possible scenarios for a post-fractured society, making particular use of Fraser's concepts on 'reactionary' versus 'progressive populism', and conclude with a comment on sociology and engagement. [ABSTRACT FROM AUTHOR]

There has been a distinct neglect of dis/ability in socio-cultural analysis of poverty porn. This paper applies framing analysis to reality TV documentaries that feature larger bodied, disabled, welfare claimants to examine how cultural literacies of fatness and 'obesity' are drawn upon to cast suspicion upon disability welfare claimants in so-called poverty-porn. With a focus on Channel 5's Benefit Britain series, Benefiits Too Fat to Work we demonstrate that enduring and harmful representations of 'obesity' are put to the work of securing public consent for a post-welfare society in the UK. [ABSTRACT FROM AUTHOR]

Purpose: Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.Methods: A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.Results: The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.Conclusions: Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly. [ABSTRACT FROM AUTHOR]

Hospital in the home is a relatively new concept within the UK healthcare system. The Guy’s and St Thomas’s NHS Foundation Trust (GSTT) @home service ‘Bringing hospital care to your home’ was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients’ place of residence by facilitating rapid discharge from hospital. The service is designed for 260–280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health. The main criteria for referrals are adults, living within Lambeth or Southwark with an acute onset of illness often with acute exacerbations of chronic conditions. Care is delivered using 25 clinical pathways using integrated care teams, including those for respiratory disease, heart failure and palliative care services. Recently, the service extended to include overnight palliative care. As care shifts from hospital to the community, it is envisaged that these types of programmes will become an essential component of care provision. This paper describes the service and presents initial service evaluation data. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to set out the Law Commission's proposals for the reform of the law relating to UK health professional regulation and, in England only, social workers. Design/methodology/approach – The paper summarises the main provisional proposals from the consultation paper. Findings – The consultation paper argued for the reform of the law in this area. Practical implications – There are suggestions for reforming the law which could form the basis of a new legal framework introduced in 2014. Originality/value – The paper sets out the proposed new legal framework. [ABSTRACT FROM AUTHOR]

This paper describes the details of a strategy developed to evaluate intervention outcomes of a number of community-based programmes. The rationale for the development of the strategy and its reception into practice is also described. This paper contributes to the debate about qualities and characteristics of appropriate evidence for health promotion by detailing the package of tools developed. These drew on health impact assessment, theories of change and participatory appraisal. In particular, the impact of context on evaluation is highlighted. Although this work is focused on community health promotion officers in the UK, the issues are relevant to a wide range of workers such as public health nurses and community development workers internationally. Alongside the description of the evaluation process is an exploration of power and empowerment of stakeholders in public health services' planning and evaluation. Power, in terms of that afforded by tools and language, held by the different stakeholders is one of the key determinants shaping a service. This makes for a rather ambitious and complex paper; however, the authors consider it is a timely and worthy challenge to address. [ABSTRACT FROM AUTHOR]

The increasing significance of the role of the general practitioner (GP) in the British National Health Service, evolving from a provider to purchaser and now a key player in the organisation of Primary Care Groups, suggests the need for GPs to possess more and more information about their registered population. GP catchment areas, though an essential basis for providing GPs with important information such as levels of accessibility to surgery, are rarely clearly or accurately defined. Previous approaches towards the definition of GP catchments have been confined to single regionalisation methods, such as mean distance measures, and are prone to problems of either overestimating or underestimating medical service areas. This problem is compounded by a lack of acknowledgement that the application of contrasting catchment methodologies to a common service population has the potential to yield vastly different results which can have serious implications for health care planning and resource allocation. The lack of sophistication in the definition of medical service areas calls for a new methodology to be considered. In this paper, attention is given to the adaptation of multidimensional regional analytical techniques developed outside the health domain and applied in a Regional Health Authority in Northern Ireland. The technique involves the creation of a Synthetic Data Matrix (SDM) which compares patient to GP flow (affiliation) information aggregated at the Census Enumeration District level across a number of catchment areas created using different methodologies. The SDM is then analysed using a modified version of the European Regionalisation Algorithm to create an optimal set of non-overlapping regions according to pre-defined population size and self-containment criteria. The results, a set of compact, robust and highly self-contained catchments, are extremely encouraging. The paper considers the future potential use of such a methodology for health care planning and highlights areas for further research in this field. [ABSTRACT FROM AUTHOR]

The article presents information on the future of public health in Great Britain. This paper reviews the government's early commitment to, and initiatives in, public health which formed the foundations of its present policy, and examines the reasons for public health becoming an issue of almost unprecedented prominence. Finally, it looks ahead to anticipate what public health might look like in the aftermath of the White Paper expected in November 2004. Public health underwent something of a renaissance following the election of the Labor government in 1997.

Study objective: To explore the role of history in public health and its relevance to current practice and professional development. Design: An analysis of the issues surrounding the poor attention paid to the history of public health by its current practitioners. Setting: The paper is written from the perspective of practitioners in the UK but has wide applicability. Main results: The paper makes the case that the current neglect of public health history is to the detriment of public health practice. Conclusions: There is a strong case for more attention to be paid to public health history in professional formation, development, and communication. [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]

Pressure is increasing on health care providers in the UK to demonstrate that they incorporate the views of users when planning and evaluating services. Most recently this has been seen in the commissioning of the National Patients' Experiences Survey. It is timely therefore to review the progress that has been made in trying to access the user's perspective. The aim of this paper is to assist individual service providers in planning their own strategy of user involvement and evaluation, based on an awareness of the current state of knowledge in this area. It reviews the results of research in the field of patient satisfaction over the last 20 years; summarises the main problems in the area, and suggests ways forward. Three main points emerge: the importance of developing and substantiating theory in this fiercise care if using quantitative methods and global satisfaction scores, until the process of evaluation is better understood, and the need to consider how a sensitive user-led agenda can be developed. The paper calls for a pause for reflection on the reason for our inquiry into user opinion, and for careful consideration of how we might best design studies to obtain information to fulfil this inquiry. [ABSTRACT FROM AUTHOR]

The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. [ABSTRACT FROM PUBLISHER]

Accessible summary People with learning disabilities find it difficult to get their health checked and to get information about their health., Community learning disability nurses play an important role in supporting people with learning disabilities to stay healthy., Community learning disability nurses support people with learning disabilities to get their health checked and to get information about their health., Summary International studies have shown poor uptake of public health initiatives by people with learning disabilities. In addition, studies have shown that people with learning disabilities experience poor access to public health services. The contribution of community learning disability nurses in meeting the public health needs of people with learning disabilities has evolved differently across the UK resulting in conflicting understanding of this role. This paper reports on a study that explored and explained the contribution of community learning disability nurses in the implementation of public health policies for people with learning disabilities. The study demonstrates that community learning disability nurses are involved in health surveillance, health promotion, health facilitation, health prevention and protection, health education, and healthcare delivery. [ABSTRACT FROM AUTHOR]

Research Highlights and Abstract The article investigates which of two competing accounts of contemporary British policy making better captures the nature of policy making during episodes of major reform of the English NHS., The analysis of the formulation of the English NHS Plan 2000 suggests that the Asymmetric Power Model better describes the reality of NHS policy making under New Labour than the Differentiated Polity Model., Although the process of developing the Plan showed signs of a more open policy process, it was tightly controlled and personally led by the Secretary of State for Health and his close advisers, reflecting an underlying British political tradition that emphasises the idea that the NHS has to be continuously improved with change led from above by central government., However, when compared to the processes underpinning Thatcher's Ministerial Review of the NHS and the 2010 Coalition government's White Paper, if ever NHS policy making in England were to have come close to the Differentiated Polity Model, it would have been during the formulation of the 2000 NHS Plan., Through a case study of the formulation of the English NHS Plan 2000, this article investigates which of two competing models of the British policy process-the Differentiated Polity and Asymmetric Power Models-better describes the reality of major NHS reform policy making under New Labour. The process of developing the Plan showed signs of a more open policy process, seemingly closer to the DPM. There was contestability of policy advice and limited involvement of the medical profession through its representative bodies. However, the process was tightly controlled and personally led by the Secretary of State and his advisers, with the direct involvement of the Prime Minister throughout. Two key moments of interest group involvement-the Modernisation Action Teams and the signing of the Plan by health sector organisations-were marked by power asymmetries. Overall, the APM better describes the reality of major reform policy making under New Labour. [ABSTRACT FROM AUTHOR]

It has been suggested that asset-based strategies could provide an opportunity to rethink the approach to public health; however, this may not be a viable option unless there is clear recognition of specific individual assets. Although there has been some consideration of assets within a child health context, this is limited and previous studies have not sought to identify assets from the perspective of the child. This paper reports on a study that drew on an ethnographic approach, using a photo-elicitation method, to facilitate the mapping of children’s internal and external assets from the viewpoint of children themselves. Two primary schools in the South-East of England were used to recruit 20 year five children (aged 9–11 years of age). The participants, 10 boys and 10 girls, were given disposable cameras and asked to take photographs of the activities that they enjoyed. The children’s photographs were used as prompts during individual semi-structured interviews. A constant comparative analysis facilitated the mapping of the children’s assets as the children described them; this process revealed one overall stabilising asset (‘My Family’) as well as eight internal and three external assets. All of the assets are presented within an original model, ‘I’m good’: the children’s asset wheel [CAW], which was developed from the findings. It is suggested that the CAW could complement previous asset-based work to facilitate the rethinking of approaches to the enhancement of children’s public health. [ABSTRACT FROM PUBLISHER]

Purpose – The Report on the Consultation on the Review of No Secrets, published by the Department of Health in 2009 highlighted the need for commissioners to take more responsibility, in partnership with regulators, for safeguarding people who use services. This article aims to focus on resources that support the role of commissioners to maintain or improve the quality of services to reduce the likelihood of abuse, neglect or harm. Design/methodology/approach – The article is based on the content of two SCIE resources. The first looks at all of the monitoring mechanisms a commissioner can draw upon to monitor good quality without overlap with inspectors or overburdening the provider. The second looks at common areas of practice that lead to safeguarding referrals in care homes. Working with a group of 30 practitioners, comprising largely commissioners and providers, a guide to preventing some of the problems that frequently lead to safeguarding referrals from care homes was developed. Findings – The first SCIE product on which the article is based outlines the mechanisms available to care home commissioners that can be utilised to improve safeguarding. The second, based on work with practitioners, highlights some of the issues that frequently lead to safeguarding referrals from care homes. These are often the result of poor quality services and poor practice rather than malicious intent. The work demonstrates that commissioners could improve the quality of residential services through better partnership working and better use of available intelligence to reduce the risk to those in residential care. Practical implications – There are numerous steps that both commissioners and providers can take to improve the prevention of abuse, neglect and harm towards people in residential care. Social implications – The guides highlighted in this article have the potential to improve practice in commissioning and, as a consequence, to provide better quality and safer residential care services. Originality/value – The value of the paper is to support commissioners to better safeguard people in residential care. [ABSTRACT FROM AUTHOR]

The counselling and psychotherapy profession is undergoing considerable change as a result of government intervention in the form of regulation, funding and efficacy research. In this paper we argue that these changes, even though they challenge some of the basic ways of thinking which have come to underpin the profession since its inception, also offer an opportunity to stimulate debate and thought in regard to how the profession might contribute to the development of healthcare systems in the future. We argue that this could be enhanced if therapists can learn from the experience of practitioners in the field of complementary and alternative medicine (CAM), which has been experiencing similar changes in recent years. Indeed, both fields of clinical activity adopt many similar underlying clinical principles and, according to Samuels (2001), have similar political outlooks. With reference to anthroposophic psychotherapy which, as well as being a form of psychotherapy, is also part of a ‘whole systems’ approach to CAM, we will examine those characteristics of psychotherapy and CAM that can inform the thinking of healthcare systems as a whole. [ABSTRACT FROM PUBLISHER]

Public health policy has arguably taken a new direction in the UK since 1997. This is typified by a review of the public health workforce. A key profession within this workforce is that of health visiting. Starting Well, a Scottish National Health Demonstration Project is one attempt to develop the public health role of health visitors. The project aimed to improve child health by providing intensive home visiting to families in Glasgow. This paper reports on a process study focused on whether Starting Well, an intervention exemplifying contemporary public health policy, could be operationalised through health visiting practice. Semi-structured interviews were conducted with a purposive sample of 44 staff responsible for developing and implementing the programme. Whilst greater contact with families allowed health visitors to develop their understanding of the life circumstances of their case-load families, the evaluation raised issues about the feasibility of systematically changing practice and demonstrated the difficulties of implementing an approach that relied as much on individual values and organisational context as formal guidelines and standardised tools. Furthermore, the ability of the systems and structures within which practitioners were operating to facilitate a broad public health approach was limited. The policy context for public health demands that increasing numbers of health workers are familiar with its principles and modus operandi. It remains, however, a contested area of work and its implementation requires change at a number of levels. This has implications for current policy assumptions about improving population health. [Copyright &y& Elsevier]

Public policy for people with an intellectual disability has been shaped since 1945 by universalistic ideas of human rights and social inclusion. These universalistic ideas are increasingly under challenge from consumerist ideas, which is reflected in public policy in the New Public Management (NPM). NPM involves a critique of poor coordination and quality in public services, and proposes the enhancement of consumer choice through a greater diversity of providers and market mechanisms to allow consumers to select between them, partnership arrangements to improve coordination, and target-setting and monitoring by governments. NPM has been widely applied internationally in the reform of public services, and has been implemented for services for people with an intellectual disability in England, following the white paper Valuing People in 2002. There is limited research data on the outcome of this policy, but it indicates that: (1) enhanced choice to be achieved by person-centered planning has probably affected only a minority of those eligible and has not changed access to public services; and (2) partnership boards have primarily existed to convey and manufacture consent for centrally determined policies. These problems match those identified in surveys of NPM in other sectors, but there is an additional concern that the consumerist ideas incorporated in Valuing People may be used by governments to replace, rather than supplement, policies to directly enhance access to public services through such measures as antidiscrimination laws. The review indicates a need to assess policies for people with an intellectual disability, in a wider social context and through international comparative research. [ABSTRACT FROM AUTHOR]

Health research is fundamental to the development of improved health and healthcare. Despite its importance, and the role of policy in guiding the kind of research that gets addressed, there are very few empirical studies of health research policy. This paper redresses this, exploring the means by which one area of health research policy is shaped, enabled and constrained. We ask: what are the historical, social and political origins of research policy in primary care in England? What are the key discourses that have dominated debate; and what are the tensions between discourses and the implications this raises for practitioners and policymakers? To answer these questions we employed a Foucauldian approach to discourse analysis to explicitly recognise the historical, social and ideological origins of policy texts; and the role of power and knowledge in policy development. We adapted Parker''s framework for distinguishing discourses as a means of selecting and analysing 29 key policy documents; 16 narrative interviews with historical and contemporary policy stakeholders; and additional contextual documents. Our analysis involved detailed deconstruction and linking across texts to reveal prevailing storylines, ideologies, power relations, and tensions. Findings show how powerful policy discourses shaped by historical and social forces influence the type of research undertaken, by whom and how. For instance, recent policy has been shaped by discourse associated with the knowledge-based economy that emphasises microscopic ‘discovery’, exploitation of information and the contribution of highly technological activities to ‘UK plc’ and has re-positioned primary care research as a strategic resource and ‘population laboratory’ for clinical research. Such insights challenge apolitical accounts of health research and reveal how health research serves particular interests. [Copyright &y& Elsevier]

Background: Despite evidence that physical inactivity is a risk factor for a number of diseases, only a third of men and a quarter of women are meeting government targets for physical activity. This paper provides an estimate of the economic and health burden of disease related to physical inactivity in the UK. These estimates are examined in relation to current UK government policy on physical activity. Methods: Information from the World Health Organisation global burden of disease project was used to calculate the mortality and morbidity costs of physical inactivity in the UK. Diseases attributable to physical inactivity included ischaemic heart disease, ischaemic stroke, breast cancer, colon/rectum cancer and diabetes mellitus. Population attributable fractions for physical inactivity for each disease were applied to the UK Health Service cost data to estimate the financial cost. Results: Physical inactivity was directly responsible for 3% of disability adjusted life years lost in the UK in 2002. The estimated direct cost to the National Health Service is £1.06 billion. Conclusion: There is a considerable public health burden due to physical inactivity in the UK. Accurately establishing the financial cost of physical inactivity and other risk factors should be the First step in a developing national public health strategy. [ABSTRACT FROM AUTHOR]

Attaining quality health care has long been a social policy priority for countries internationally. This discussion considers issues important to understanding quality, and audit implementation in particular. The paper covers, first, the principles and practice of audit and, second, broader implementation issues, which together point to the further development of quality initiatives in health in the United Kingdom health care context. To close, the future of audit as a means of improving health care is elaborated. [ABSTRACT FROM AUTHOR]

Explores how various approaches can be integrated to help someone create an effective person-centered health action plan, a key component of the British government's “Valuing People” White Paper. Key principles underpinning person-centered planning (PCP); Interface between PCP and health action planning (HAP); Advantages and disadvantages of different PCP models in relation to HAP; Examples of health action plans.

User or patient involvement (UI) in the planning and delivery of health services is an aspiration of many industrialized economies, and has been promoted by United Kingdom (UK) governments for over two decades. This paper reports the findings of qualitative case studies of UI in two mental health provider Trusts in London. Semi-structured interviews were conducted with a variety of stakeholders, including Trust staff at all levels and user group members, to compare the expectations of diverse stakeholders and the extent to which these were achieved. We found that UI remained in the gift of provider managers: providers retained control over decision making, and expected users to address Trust agendas and conform to Trust management practices. Users wanted to achieve concrete changes to policies and services, but had broader aspirations to improve the status and condition of people with mental health problems. Suggestions are made about the direction of future strategies to improve UI. [Copyright &y& Elsevier]

Public health in the UK has undergone major changes since 1997. One of the main debates has focused on the function and delivery of the broad task of health improvement. This is no longer the province of doctors alone but of a new cadre of professionals now termed the multidisciplinary workforce. Establishing the coherence and cohesion of the professionals and practitioners from different backgrounds and disciplines who are expected to carry out these tasks has been the concern of policy makers and professional bodies. The route to achieve this has been through the delineation and specification of public health functions and the regulation of its training and career structures. Little, if any, attention has been given to understanding the role of values and the part played by an explicitly articulated shared purpose in building a unified and harmonized workforce. The material for this paper draws from an exploratory project undertaken by London South Bank University, the King's Fund and the Office for Public Management and presented as a case study at the UKPHA conference in Cardiff 2003. [ABSTRACT FROM AUTHOR]

A new Labour government was elected in the UK in May 1997 with a strongly stated commitment to improving public health and tackling inequalities. This focus on public health was part of a concerted attempt to tackle poverty and social exclusion through 'joined up thinking' across central government. Thus health inequalities were to be tackled 'upstream' through wider government initiatives. Fundamental to the government's policy has been the development of public health capacity, including a more multi-disciplinary public health workforce and greater partnership working at local level. Improving public health is a long-term project, however, and politicians' decisions are often driven by short-term election cycles. Midway into its first term, the government published The NHS Plan which re-focused policy attention on the problems of the health care system. As the 2001 election approached, the government launched Shifting the Balance of Power, a major re-organization of the English NHS with the intention of improving the 'delivery' of health care, but which also had profound implications for the public health function. This paper argues that UK government policy towards public health has been characterized by continuing and fundamental tensions. Far from empowering public health practitioners, these tensions in central policy have contributed to practitioners' uncertainty about their roles, and how they can meet the centre's increasing demands for demonstrable 'delivery'. The implications are considered for building capacity in the UK and for a wider systems understanding of capacity issues. [ABSTRACT FROM AUTHOR]

Recent UK government policy calls for a strong public health function within health and local authority services. The recent restructuring of the National Health Service has drastically changed the organizational structure of Public Health, and has resulted in concerns over the capacity and capabilities of the specialist public health workforce. This paper presents findings from the first phase of a study assessing the capacity and development needs of specialists in public health. Face-to-face semi-structured interviews were conducted with a purposive sample of key public health informants. Four key themes were identified. First, interviewees noted the lack of clarity encompassing the term 'specialist in public health' and the consequent confusion regarding the role of a specialist and the public health function. Second, concern was expressed over the recent fragmentation of the workforce, the loss of critical mass and the potential for professional isolation. This was seen as particularly worrisome in light of a growing public heath agenda. Third, respondents identified key skills gaps within the workforce such as health protection, partnership working and leadership. Last, inadequacies and regional inequities in training and continuing professional development were identified, with interviewees calling for these issues to be addressed immediately. Capacity and skills gaps in the specialist public health workforce are evident and exacerbated by the confusion surrounding the definition of a specialist and, hence, individual roles and responsibilities. The ability of the public health workforce to meet the growing public heath agenda will be dependent on the success of various new mechanisms for joint working, capacity building, and skill enhancement. [ABSTRACT FROM AUTHOR]

Wales has been in the forefront of moves to establish a children's commissioner in Great Britain for a number of years. The efforts really began to gather a momentum and focus with the establishment of the National Assembly for Wales (NAW) in 1999. With the exception of the Conservatives, all of the main political parties included a promise to establish such a post in their manifesto for the Assembly elections. The lead was taken by the Health and Social Services Committee (HSSC), which adopted this task as a major priority and managed to command all party support. The HSSC laid its final report before the Assembly on May 31, 2001. The paper outlined a wide-ranging remit for the Commissioner, and placed a strong emphasis on children's rights and direct involvement of young people in its work. There are a number of other initiatives that are helping towards better health care of children. The NAW is supporting and funding Young Voice, an organisation run by young people that will feed their views into the Assembly.

Analyzes public health policy in Great Britain as of January 29, 2005. Contents of the White Paper on public health entitled "Choosing health: making healthy choices easier," from the Department of Health for England; Importance of developing a philosophical basis for public health policy; Discussion of balancing the influence of government and individual responsibility for public health; Focus of British public health policy on the provision of information to inspire changes in unhealthy behaviors; Critique of the research process by which public health policy effectiveness is tested.

The article discusses the position paper issued by the Royal College of Nursing (RCN). Among the issues tackled in the statement are the ongoing fitness for purpose of the learning disability nursing workforce, the relationship between education and practice, changing pre- and post-registration education, and the distinct contribution of registered nurses and healthcare support workers. The paper focuses on the elements of education, workforce and leadership.

The Worldwide Hospice Palliative Care Alliance (WHPCA) is an international non-governmental organization registered as a charity in England and Wales that was established in 2008 following a series of international gatherings that highlighted the important need for palliative care to be included in global policy and health planning. The vision of the WHPCA is a world with universal access to hospice and palliative care. Its mission is to foster, promote and influence the delivery of affordable, quality palliative care. This article describes the evolution of the WHPCA and what it has been able to accomplish in the eight years since its formation. These accomplishments include effective advocacy with United Nations bodies, acceptance as a non-governmental organization in official relations with the World Health Organization and the UN Economic and Social Council, publication of many position papers on critical aspects of palliative care, publication of the Global Atlas of Palliative Care at the End of Life, development of toolkits for palliative care development, publication of the international edition of ehospice, and management of World Hospice and Palliative Care Day each year. Some of the many challenges to the growth and development of palliative care globally are described along with future plans. [ABSTRACT FROM AUTHOR]

Opinion. Examines the implications of the 1997 white paper concerning the United Kingdom National Health Service, for accountability within the service. Directions which accountability take in the white paper; Impact which these forms may have on management style of health services; Risks of planning based on functional rather than structural mechanisms.

The article provides information on care planning process. It states that the process should support the patient to be in control of their health. Questions that can help make the goals in a care plan achievable and realistic are listed. Self-management training programs are reportedly available to give people the skills to fully engage in their care. Also noted is the White Paper released by the British government which pledged that all people with a long-term health condition should have the opportunity to have a care plan by 2010.

Reports on an approach to medical practice in the United Kingdom in which patients will be actively encouraged to become partners in decisions about their treatment. Increase in health user groups; Use of the Internet to widen the information base; Increase of patient choice of hospitals for elective surgery; Reference to a December 2003 policy paper entitled "Building on the best--choice responsiveness and equity in the NHS"; Role of Harry Cayton in the push for more patient involvement.

Reports that at least 22 local health groups in Wales will take on the responsibility of commissioning health services there, according to a white paper on the future of the United Kingdom National Health Service (NHS) in Wales. Cornerstone of the proposed structure for Wales' NHS; Other changes to take place in the service; Comments from Win Griffith, Welsh health minister.