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This paper is a narrative review of the use of collective terminology in relation to race and health in Britain, with particular reference to the 'Black African' community. 'Black Africans' have been categorised in the 1991–2011 censuses with added free‐text in 2021 in response to user demand. However, the UK government is increasingly reporting data for the 'Black' pan‐ethnicity, especially in the even more generalised 'BAME' ('Black, Asian and Minority Ethnic') acronym in COVID‐19 pandemic reports. The consequences of this practice are addressed. Firstly, with respect to ethical challenges, Black Africans find their conscription by government into the term BAME offensive and do not accept it as a self‐descriptor. This labelling, which subsumes Black Africans' self‐assigned ethnicity in the census, and consequent misrecognition may be interpreted as a micro‐aggression (a term coined in the 1970s but used here to denote microinvalidation), as suggested in the current black activism of the 'Black Lives Matter movement'. Secondly, ONS has warned that concealed heterogeneity renders the pan‐ethnicities unreliably crude, making them scientifically inaccurate. Analysts are recommended to present ethnic group data for the full census classification where possible for reasons of validity and respect for the patient as arbiter of their ethnic group. [ABSTRACT FROM AUTHOR]

The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel. [ABSTRACT FROM AUTHOR]

Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

Recent UK health policy initiatives promote a ‘no blame culture’ and learning from adverse events to enhance patient safety in the NHS. Similar initiatives exist in the USA and Australia. Changing the ‘blame culture’ in the NHS has been advocated in policy documents and inquiry reports for over a decade. Some key concepts that are used in the policy discourse –‘blame’; mistakes, errors and misdemeanours; and ‘culture’– are examined and considered in the light of pertinent social science literature to question some of the assumptions concerning these terms in the policy discourse, and to suggest some alternative questions and perspectives. The Three Inquiries, a recent series of statutory inquiries held in the UK, are used as a case study to explore some of the intra- and inter-professional difficulties of reporting errors and misconduct by medical practitioners. The paper offers an interpretive social science perspective as an alternative to more policy oriented and managerial approaches to patient safety issues, focusing on deeper structural aspects of organisational phenomena implicated in the ability or otherwise of medical and other healthcare staff to report mistakes and misconduct as one aspect of patient safety. [ABSTRACT FROM AUTHOR]

In this paper two disparate areas of social science theory, actor–network theory and policy networks, will be brought to bear on the problem of explaining the rapid development of an area of medical science and health policy in the UK. There has been a surge of interest in the treatment and management of personality disorder from within both the psychiatric profession and government ministries, and particularly those personality disorders deemed to be severe or dangerous. This has resulted in the development of a new psychiatric classification, the ‘dangerous and severe personality disorder’ (DSPD), and the funding and development of a new service to deal with it. Major new mental health legislation has been set in train to provide legal backing for the pre–emptive detention of patients with such a diagnosis, despite widespread uncertainty over its status, reliability or predictive capability. In the process of presenting and analysing this development, actor–network theory and policy networks will themselves be reviewed and compared, and common and incompatible elements, foci and mechanisms identified. [ABSTRACT FROM AUTHOR]

In recent years international bioethics bodies have made prominent declarations about the uses of donated tissue and related information in genetic research 1 . Following the ‘legislative’ mode of bioethics 2 , these organisations have put forward a number of general principles with a view to promoting the fair and equitable use of donated tissue in such research. However, government policies in this field are shaped differently in different national regimes. In this paper, I use recent debates in the UK about a national genetic ‘biobank’ to illustrate how the shape and texture of policy discussions surrounding the use of donated blood for genetic research have been built upon a prior national consensus that regarded blood as a public good. [ABSTRACT FROM AUTHOR]

In this article we use the example of race/ethnic inequalities in severe mental illness to demonstrate the utility of a novel integrative approach to theorising the role of racism in generating inequality. Ethnic minority people in the UK are at much greater risk than White British people of being diagnosed with a severe – psychosis related – mental illness, and this is particularly the case for those with Black Caribbean or Black African origins. There is entrenched dispute about how we might understand the drivers of this inequality. To address this dispute we build on, and to a certain extent refine, established approaches to theorising structural and institutional racism, and integrate this within a theoretical framework that also incorporates racist/discriminatory interactions (interpersonal racism). We argue that this provides a conceptually robust and thorough analysis of the role of inter‐related dimensions of racism in shaping risks of severe mental illness, access to care, and policy and practice responses. This analysis carries implications for a broader, but integrated, understanding of the fundamental drives of race/ethnic inequalities in health and for an anti‐racism public health agenda. [ABSTRACT FROM AUTHOR]

The background to this article is the medical regulation of sperm donation in the UK and the recent policy change so that children born from sperm, eggs or embryos donated after April 2005 have the right to know their donor's identity. I draw upon data from interviews with ten women and seven joint interviews with couples who received donor insemination from an anonymous sperm donor and were the parents of donor insemination children. I explore the symbolic presence of the donor and his potential to disrupt social and physical boundaries using the theoretical conceptions of boundaries and pollution as articulated by Mary Douglas and Julia Kristeva. I present data to argue that the anonymous donor manifests in various figures; the shadowy and ambiguous figure of ‘another man’; the intelligent medical student; the donor as a family man, with children of his own who wants to help infertile men father children. In addition participants perceive the donor's physical characteristics, but also see their husband's physical characteristics, in their children. In conclusion I argue that anonymisation preserves features of conventional family life, maintains the idea of exclusivity within the heterosexual relationship and affirms the legal father's insecurity about his infertility. [ABSTRACT FROM AUTHOR]