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Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care. Plain Language Summary: This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. Design/methodology/approach: This paper aims to present a thematic synthesis of mental health policies published in England from 1999 to 2020. The authors specifically focus on ethnicity-related mental health issues highlighted in policies, policy recommendations and performance measurements of policy implementation. Findings: Findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the past two decades. Ongoing issues include a lack of data on the ethnicity of mental health services users. Where data is available, these highlight ethnic inequalities in access to, experiences of and outcomes of mental health services, as well as a lack of cultural capability in health-care professionals. Policy recommendations have also remained the same during this time and include: collecting data on the ethnicity of service users, raising awareness of the cultural needs of Black and Minority ethnic populations amongst health-care professionals, recruiting BME staff into mental health care services and improving community engagement. The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Practical implications: The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Originality/value: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how any proposed Women's Health Strategy could address the needs of women affected by dementia in England. Design/methodology/approach: The authors take the following three perspectives: women living with dementia, female carers and female practitioners supporting people with dementia. Findings: In this paper, the authors explore the current evidence about dementia and female gender under three main strands relating to policy and practise. Originality/value: There is worldwide interest amongst policy communities in gender inequalities. [ABSTRACT FROM AUTHOR]

Making Every Contact Count (MECC) is a national, long‐term public health strategy in England. It supports public‐facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under‐represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi‐stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi‐structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self‐reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels—national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a 'double‐edged sword,' in light of associated challenges such as sector‐level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long‐term sustainability challenges. The recommendations call for system‐level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes—particularly in relation to seldom‐heard client groups. [ABSTRACT FROM AUTHOR]

Despite increasing evidence of the impact of health inequalities on mental health (Pickett and Wilkinson, 2015), there is only limited recognition of the potential role for mental health social work in addressing 'upstream' as well as 'downstream' challenges of poverty, disadvantage and oppression affecting many people experiencing mental health difficulties. This paper presents some of the current evidence concerning mental health inequalities and the opportunities for mental health social workers to promote well-being. A theme throughout the paper is the need to avoid the many examples of dichotomous thinking that frequently characterise thinking about mental health and mental health practice. Additionally, the limitations of an individualised recovery discourse are acknowledged. Drawing on Krieger's (2011) eco-social model, the social determinants of mental health are considered and the concept of embodiment is examined for its contribution to a more nuanced understanding of the relationship between inequality and health. Finally, the paper offers a version of mental health social work that 'faces both ways', involving issues at both the individual and the wider societal levels. This includes developing and extending partnerships with service users and carers and with other professional and agencies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a commentary on “A summary of government initiatives relating to employment for people with learning disabilities in England”. Design/methodology/approach – In her paper, Blamires outlines the development of policy in employment for people with learning disabilities. This commentary explores whether this policy development is having any impact. Findings – The statistics indicate that development of policy does not appear to be making a difference. It is concluded that this is about how it is being implemented and the time it takes for policy to have an impact. What is needed to fully implement these changes is a huge cultural shift, changing people’s mindset about what people with learning disabilities can achieve. Originality/value – This paper provides an individual perspective on the impact of policy on the lives of people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a synthesis of current and previous government policies and strategies, in relation to people with learning disabilities and employment, to facilitate a better understanding of the current situation and future challenges. Design/methodology/approach – A search was completed to identify government policies relating to the employment of people with learning disabilities. Key policies were identified and their impact was discussed in the paper. Findings – It appears there is a necessity to identify how successful pilot projects can be replicated on a national scale, with clear targets and measures and initial financial support to set up these services. Alongside this there is a need for interventions targeting not just employers, but the general population, educating people about the importance of including and valuing people with learning disabilities in the workforce. Originality/value – It is important that policy is analysed and the impact of it is assessed to determine whether more action is necessary. This paper adds updates to some of the issues discussed in Melling et al.’s (2011) paper about “Supported employment for people with learning disabilities”. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe the principal challenges facing the health and care system in England arising from an ageing population, assess the track record of the coalition government in addressing these and offer a perspective on the priorities likely to be faced by the next incoming government in relation to health and social care for older people. Design/methodology/approach - Assessment of key policy documents and legislation and interpretation of published data on trends in health and social care activity and expenditure. Findings - An ageing population requires a fundamental shift towards a new model of care that offers better coordinated care and promotes independence and healthy ageing. The Care Act 2014 is a significant achievement and NHS spending has been protected, but resulting cuts to local government budgets have since sharp reductions in social care for older people. The next incoming government will need to address a deepening financial crisis in health and care system; the increasingly unsustainability of means tested and rationed social care alongside universal free health care; and the need to make faster progress in developing a new models of integrated care closer to home. Originality/value - The issues raised in this paper affect older people as voters, tax payers and as existing or potential users of health and social care services. As a group they will attract significant attention from political parties in the next election campaign. [ABSTRACT FROM AUTHOR]

Deafblindness is a particularly complex impairment and deafblind people are considered to be some of the most vulnerable members of society; this includes vulnerability to abuse and harm. This paper explores this unique impairment in the illustrative case of Beverley Lewis, by reviewing archived published and audio material about the life and circumstances of the death of this young woman, including media reports, parliamentary debates and commentaries. Whilst it appears that the implications of Beverley's deafblindness may have been ‘overshadowed’ in media reports and inquiries, the paper suggests that further lessons for practice can be learned from the case by focusing on this condition. Drawing on contemporary research by specialist charitable organisations (Sense and Deafblind UK), the authors identify research highlighting deficiencies in support for many deafblind adults, which have implications for safeguarding policy and practice. It is concluded that attention is needed in three areas: increased awareness amongst social care and health practitioners of the particular vulnerability to abuse of deafblind adults; improved access to specialist assessment and specialist social care support, including one-to-one human support; and improved communication between social care and health agencies, alongside more tangible signs of acceptance of shared responsibility for supporting deafblind adults. [ABSTRACT FROM AUTHOR]

Background: Health service reconfigurations are of international interest but remain poorly understood. This article focuses on the use of evidence by senior managerial decision-makers involved in the reconfiguration of stroke services in London 2008-2012. Recent work comparing stroke service reconfiguration in London and Manchester emphasises the ability of senior managerial decision-makers in London to 'hold the line' in the crucial early phases of the stroke reconfiguration programme. In this article, we explore in detail how these decision-makers 'held the line' and ask what the broader power implications of doing so are for the interaction between evidence, health policy and system redesign.Methods: The research combined semi-structured interviews (n = 20) and documentary analysis of historically relevant policy papers and contemporary stroke reconfiguration documentation published by NHS London and other interested parties (n = 125). We applied a critical interpretive and reflexive approach to the analysis of the data.Results: We identified two forms of power which senior managerial decision-makers drew upon in order to 'hold the line'. Firstly, discursive power, which through an emphasis on evidence, better patient outcomes, professional support and clinical credibility alongside a tightly managed consultation process, helped to set an agenda that was broadly receptive to the overall decision to change stroke services in the capital in a radical way. Secondly, once the essential parameters of the decision to change services had been agreed, senior managerial decision-makers 'held the line' through hierarchical New Public Management style power to minimise the traditional pressures to de-radicalise the reconfiguration through 'top down' decision-making.Conclusions: We problematise the concept of 'holding the line' and explore the power implications of such managerial approaches in the early phases of health service reconfiguration. We highlight the importance of evidence for senior managerial decision-makers in agenda setting and the limitations of clinical research findings in guiding politically sensitive policy decisions which impact upon regional healthcare systems. [ABSTRACT FROM AUTHOR]