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Meeting individuals' social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of 'unmet need' remain a challenge. This paper advances our understanding by incorporating a temporal dimension into the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 8 and 9 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (a) no longer having such a need; (b) having continued needs met; (c) delayed needs met; (d) newly arisen unmet needs; and (e) repeated unmet needs. The results indicate that amongst those with need at baseline, unmet need has decreased over time – indicating that some needs for social care may be fulfilled with a delay. However, a significant proportion of older people experienced repeated unmet needs, particularly those who were younger, with no spouse or civil partner, and those whose activities of daily living index scores worsened over time. Understanding the dynamics of unmet need can support policy makers in better ensuring that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net. [ABSTRACT FROM AUTHOR]

Introduction: Developments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues. Purpose: To assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals. Methods: We will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites. Evaluation plan: We will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews. Ethics: Approval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001). Dissemination: Findings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings' website. [ABSTRACT FROM AUTHOR]

The number of older self-funders in England is growing in the context of tight eligibility criteria and fixed financial thresholds to access statutory adult social care. Older people who self-fund their social care fall largely under the radar of statutory services and of research. Our study aimed to listen closely to the stories that older people tell about finding, managing and paying for their care. We interviewed 65 older people living in the community who were funding all or some of their social care. This paper focuses on narrative analysis of selected transcripts from these interviews. It sheds light on how older people represent their experiences of self-funding and what underpins these constructions. A key finding is that the disjunctions within older people's accounts between the care they want and the care they receive reflect wider political and structural tensions in the funding and delivery of care. Older self-funders temper their expectations in light of their experience of shortfalls in the system. This enables them to adjust to the deficiencies but obscures and perpetuates poor care. The discussion considers the findings in relation to: the fundamental incompatability of body labour and commodified care; the shared precarity of older people and care workers; and the individualisation of risks that makes older people and their carers responsible for making a failing care system 'work'. Our analysis adds to the case for major reform of adult social care, including a revaluing of the status and employment conditions of front-line care workers. [ABSTRACT FROM AUTHOR]

Social care to assist with the activities of daily living is a necessity for many older people; while informal care provided by family members can be a first step to meeting care needs, formal care provided by professionals is often needed or preferred by older people and their families. In England, the number of older people paying for formal care is set to rise, driven by an ageing population and the limited resources of local authorities. Little is known about how older people and their families experience the potentially disruptive processes of deciding upon, searching for and implementing such care, including the financial implications. This paper explores accounts of seeking self-funded social care in England, told by older people and their families in 39 qualitative interviews. These accounts, which we call 'care chronicles', include stories about the emergence of care needs and informal care-giving, the search for formal care, including interacting with new systems and agencies, and getting formal (paid) care, either as the recipient or an involved family member. Stories are analysed through the lens of biographical disruption, and analysis demonstrates that such disruptions can occur for older people and their families across the entirety of the care chronicle. Needing, seeking and getting care all have the potential to cause practical and symbolic disruptions; moreover, these disruptions can be cumulative and cyclical, as attempts to resolve or minimise one disruption can lead to new ones. While the concept of biographical disruption is a mainstay in medical sociology, it is less frequently applied to issues relating to social care, and most often takes embodiment as a key focus. This study is novel in its application of the concept to experiences of seeking self-funded care, and in its introduction of the concept of 'care chronicles', which invite a longer and broader view of biographical disruptions in the lives of older people with care needs and their families. [ABSTRACT FROM AUTHOR]

The historic environment—comprising a palimpsest of landscapes, buildings and objects—carries meaning and plays a crucial role in giving people a sense of place, identity and belonging. It represents a repository of ever-accumulating collective and individually held values—shared perceptions, experiences, life histories, beliefs and traditions. These social or private values are mostly ascribed by people to familiar places within this environment based on the ontological security which this everyday heritage provides. However, these values are notoriously hard to capture and categorize. This makes it difficult to incorporate them into heritage-management strategies, which typically rely on objective, fact-based datasets. In this paper, we present a new methodology to capture those elusive values, by combining Topic Modelling with the principles of Grounded Theory. Results show that our novel approach is viable and replicable and that these important values can be effectively and meaningfully integrated, thus creating more inclusive approaches to heritage management than exist currently. [ABSTRACT FROM AUTHOR]

This paper takes, as its starting point, Preston and Haines' observation in Fatal Years that social class was the most important influence on infant and child mortality in England and Wales in the early twentieth century. A subsequent study suggested that this could in part be due to the spatial distribution of the different classes across different types of place, and that some of the mortality differences by social class might actually reflect the contextual effects of healthy and unhealthy places. Although this line of argument has received a considerable amount of attention in health geography literature, it has rarely been examined for a specific historic period, and then only within particular urban areas. In this paper, we apply multi-level models to a complete count individual-level dataset of the 1911 census of England and Wales, comparing influences on infant and child mortality at the level of the individual couple and for two spatial levels. We find that although most variation in infant and child mortality operates at the individual level, there is also important variation at the two spatial levels and part of the mortality differences between social classes is better explained by the areas in which people lived rather than by their social class. A consideration of independent variables at all three levels suggests that different spatial scales capture different sorts of influences on early age mortality. [ABSTRACT FROM AUTHOR]

When governments acquire third-party social welfare services (SWS), they create institutions of acquisition. The rules and practices that governments adopt define who is able to participate, on what basis, and how prices are determined. This paper conceptualizes the institutions of SWS acquisition, their variations, and implications, in order to contribute to a deeper understanding of the link between contracting and nonprofit commercialisation. Institutions of SWS acquisition include rules of entry, participation, and assessment. Resulting acquisition regimes can be marketised to a greater or lesser extent, and this is influential through its effect on nonprofit competition. Drawing on interviews with public servants and nonprofit staff, the paper compares acquisition regimes for homelessness services in England, a regime that closely resembles a market, and Canada, a regime which is not marketised. In contrast to their non-marketised counterparts, this paper finds that marketised SWS acquisition regimes create incentives for participants to reduce prices by loss-leading or ratcheting down service quality. [ABSTRACT FROM AUTHOR]

Despite the limited exception introduced by statute in 1974, the principle that truth is and ought to be a complete defence to all actions in defamation is typically regarded as self-evident in modern English law. The fact that England stands here against not only the whole of the civilian tradition but also a number of common-law jurisdictions suggests, however, that it is not. This paper, after surveying the history of the principle in English law and the debates that it has spurred in the past, argues that English law is right on this question, but needs to understand more cogently why. This, in turn, requires an examination of the interests protected by the cause of action. It is only if we accept that it is, and is solely, reputation founded in character that the defence of veritas will be secured. [ABSTRACT FROM AUTHOR]

In 1998, a review for the Ministry of Agriculture Fisheries and Food (the predecessor of the Food Standards Agency) was published evaluating the relative merits of different dietary assessment methods against a series of factors likely to affect compliance or accuracy in low-income households. The review informed the design of a method comparison study carried out in London, UK, in 2001, in which the validity and acceptability of 4 d dietary assessment methods based on 24 h recalls, food checklists and a semi-weighed method were compared with 4 d weighed inventories and other reference measures. Results were based on observations in 384 respondents (159 males, 225 females) aged 2-90 years in 240 households. Outcomes of the comparison study included evaluations of each method made by respondents, interviewers and researchers. These findings were used in the present paper to update and extend the 1998 review. Additional factors not included in the 1998 review have been considered. This updated and extended review provides the basis for discussion of the relative merits of approaches to dietary assessment in low-income households in developed economies. The evidence presented here and elsewhere suggests that the 24 h recall is the method best suited for dietary assessment in low-income households, followed by the weighed inventory, food checklist and lastly the semi-weighed method. [ABSTRACT FROM AUTHOR]

The pressure on mental health services has not gone unremarked and is of widespread concern in England and Wales. This can have implications when a bed is being sought for a patient who has undergone a Mental Health Act assessment and is deemed to meet the criteria for being formally admitted to hospital. Once the 24 h period for assessment under section 136 of the Act has lapsed, the ongoing detention of the patient can lead to a legal grey area. Through a fictional example this paper examines the relevant case law and statute that may be used to continue the detention and explores the ethical problems that this may cause. [ABSTRACT FROM AUTHOR]

Secure property rights are usually considered to be essential for sustained economic development. In England, it is debated whether property rights have been secure since the medieval period or if they were only established after the Glorious Revolution. In this context, the paper examines the Court of Wards, which from 1540 to 1646 administered the Crown's right to take custody of children and their lands when these were held by feudal-military tenures. The paper shows that wardship was a common occurrence, its exactions arbitrary but often heavy, and that it reduced the value of lands held by these tenures. [ABSTRACT FROM AUTHOR]

During Cook's 1772–75 Antarctic circumnavigation on the HMS Resolution , he recorded the positions of hundreds of icebergs. This paper compares Cook's observations and those of Halley in 1700, Bouvet in 1739 and Riou in 1789, with the Brigham Young University/National Ice Center (BYU/NIC) and the Alfred Wegener Institute datasets. Cook's description of the iceberg plume east of the Amery Ice Shelf and the iceberg distributions in the Weddell, Ross and Amundsen Seas agree with modern data. In January 1774, Cook reached his farthest south on the shelf of the Amundsen Sea Embayment, the site of the current International Thwaites Glacier Collaboration field study. Cook's largest iceberg had a 2.5 km diameter, where power-law models show that icebergs of this size or smaller comprise 92% of their total number. In the eastern Weddell, Cook's observation of a sea-ice tongue with a much greater extent than in satellite imagery remains unexplained. Although Riou's icebergs lie 1000 km east of the BYU/NIC trajectories, application of the England and others (2020) fracture and drift model to the trajectories removes the discrepancy and means that all the ship observations are consistent with modern observations and theory. [ABSTRACT FROM AUTHOR]

Since the 1990s, human trafficking has become the battleground for competing discourses on human rights and penality. While rights solutions are generally presented as in opposition to crime-control measures, in the context of anti-trafficking interventions, rights-based initiatives and criminal governance are often linked together both discursively and in practice. Drawing on the findings of Discourse Analysis of 120 texts about trafficking, this paper explores how dominant discourses and alternative voices construct the relationship between human rights and penality. It is contended that penality is framed as a crucial tenet of human rights. Dominant discourses (the 'law enforcement' and the 'victims first' discourses) link human rights to state coercive action, seen as a necessary component of their effectiveness. Alternative voices (the 'incompatibility' and the 'transformative justice' discourses) reject the appropriateness of penal intervention, but they end up preserving what they denounce. [ABSTRACT FROM AUTHOR]

The financialization of everyday life has received considerable attention since the 2008 global financial crisis. Financialization is thought to have created active financial subjects through the ability to participate in mainstream financial services. While the lived experience of these mainstream financial subjects has been the subject of close scrutiny, the experiences of financial subjects at the financial fringe have been rarely considered. In the UK, for example, the introduction of High-Cost, Short-Term Credit [HCSTC] or payday loan regulation was designed to protect vulnerable people from accessing unaffordable credit. Exploring the impact of HCSTC regulation is important due to the dramatic decline of the high-cost credit market which helped meet essential needs in an era of austerity. As such, the paper examines the impact of the HCSTC regulation on sixty-four financially marginalized individuals in the UK that are unable to access payday loans. First, we identify the range of socioeconomic strategies that individuals employ to manage their finances to create a typology of financial subjectivity at the financial fringe. Second, we demonstrate how the temporal and precarious nature of financial inclusion at the financial fringe adds nuance to existing debates of the everyday lived experience of financialization. [ABSTRACT FROM AUTHOR]

Aim: To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England. Background: Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this. Methods: This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach. Findings: Three themes were developed: 'Understanding the trainee role and requirements', 'Trainee support in primary care' and 'Skills and scope of practice'. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer. [ABSTRACT FROM AUTHOR]

This paper reports on a study which examined the notions of authenticity and citizenship for people living with cognitive impairment or dementia in a care home in the North-East of England. We demonstrated that both notions were present and were encouraged by engagement with an artist, where this involved audio and visual recordings and the creation of a film. The artist's interactions were observed by a non-participant observer using ethnographic techniques, including interviews with the residents, their families and the staff of the care home. The data were analysed using grounded theory and the constant comparative method of qualitative analysis. Our findings suggest that participatory art might help to maintain and encourage authenticity and citizenship in people living with dementia in a care home. Certainly, authenticity and citizenship are notions worth pursuing in the context of dementia generally, but especially in care homes. [ABSTRACT FROM AUTHOR]

The appointment of recent Attorney-Generals for England and Wales has occasioned much comment about their experience. This paper considers whether, following the transmogrification of the Lord Chancellorship over a decade ago, the backgrounds and activities of recent leaders of the Attorney-General's Office suggest the time is now right for similar changes to the Law Officers' roles. In doing so, it presents a range of original data on aspects of the role and on characteristics of Attorney-Generals, which suggests that unless self-restraint is exercised (by the Prime Minister and the post-holders) we may ineluctably be on the path to reform. [ABSTRACT FROM AUTHOR]

This paper explores telecare manager and other 'stakeholder' perspectives on the nature, extent and impact of family and other unpaid/informal carers' involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers' engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals' engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as 'resources' and involvement is largely taken for granted. There are instances in which carers can be seen as 'co-workers': this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or 'supersede' hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers' own rights as 'co-clients' was little acknowledged. [ABSTRACT FROM AUTHOR]

This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three 'types' of personalised care in care homes. These conceptualise the care home as an 'institution', a 'family' and a 'hotel'. We have added a fourth type, the 'co-operative', to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the 'family' model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost. [ABSTRACT FROM AUTHOR]

Research has suggested ecopsychosocial initiatives can promote a sense of wellbeing and inclusion in people with dementia. However, few studies have elucidated the 'active mechanisms' whereby such initiatives can achieve these outcomes, so hindering their generalisability. This is particularly pertinent when seeking to support community-dwelling older men with dementia who are reluctant to engage with traditional health and social care initiatives. This paper reports on a study that drew from the principles of Participatory Action Research to explore the 'active mechanisms' of a technological initiative for older men (65+ years) with dementia in rural England. An individually tailored, male-only initiative, using off-the-shelf computer game technology (e.g. iPad, Nintendo Wii and Microsoft Kinect) was delivered over a nine-week period. Multiple qualitative methods were employed, including: focus groups, open interviews and extensive reflective field notes, to gather data from the perspective of 22 men, 15 care partners and five community volunteers. The data were analysed thematically and interpreted using a masculinity lens. Three mechanisms contributed to the initiative's success: the use of the technology, the male-only environment and the empowering approach adopted. The paper argues that initiatives aimed at community-dwelling older men with dementia would be advised to consider these gendered experiences and ensure participants can maximise their masculine capital when participating in them, by providing enabling activities, non-threatening environments and empowering approaches of delivery. [ABSTRACT FROM AUTHOR]

This paper investigates whether high borrowing costs deterred investment in sanitation infrastructure in late nineteenth-century Britain. Town Councils had to borrow to fund investment, with considerable variation in interest rates across towns and over time. Panel regressions, using annual data from more than 800 town councils, indicate that higher interest rates were associated with lower levels of infrastructure investment between 1887 and 1903. Instrumental variable regressions show that falling interest rates after 1887 stimulated investment and led to lower infant mortality. These findings suggest that Parliament could have expedited mortality decline by subsidizing loans or facilitating private borrowing. [ABSTRACT FROM AUTHOR]

Frailty is increasingly used in clinical settings to describe a physiological state resulting from a combination of age-related co-morbidities. Frailty also has a strong 'lay' meaning that conjures a particular way of being. Recent studies have reported how frail older people perceive the term frailty, showing that frailty is often an unwanted and resisted label. While there are many scores and measures that clinicians can use to determine frailty, little has been published regarding how health-care professionals use and make sense of the term. This paper reports the findings of a qualitative study that explored how health professionals perceive frailty. Forty situated interviews were conducted with health-care professionals working in an emergency department in the English Midlands. The interview talk was analysed using discourse analysis. The findings show that the health professionals negotiate an 'ideological dilemma' – a tension between contradictory sets of meanings and consequences for action – based on their 'lay' and clinical experience of the term frailty. It is concluded that this dilemma could have a negative impact on the assessment of frailty depending on the system of assessment used. [ABSTRACT FROM AUTHOR]

Primary care interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. One of the priorities for IAPT services is to reduce inequalities in access and outcomes for potentially disadvantaged populations. This paper uses national data from the years 2012–2013 to 2019–2020 to present a comparison of service process and therapy outcomes for people with learning disabilities. Annual data for people with learning disabilities, people with other recorded disabilities and people with no recorded disabilities were extracted from a publicly available, national data source. Data are presented graphically with relative risk calculated for each variable and year, and show a broadly similar pattern of waiting time access for people with learning disabilities and people with no disabilities, and a broadly similar proportion of people with learning disabilities and people with no disabilities who finish treatment. However, people with learning disabilities have poorer clinical outcomes than people with no disabilities. We discuss adaptations to IAPT processes and therapy provision that may further support people with learning disabilities' access to IAPT services. Key learning aims: (1) To describe how IAPT services record disabilities, and in particular record whether a person identifies themselves as having a learning disability. (2) To explore the differences in processes and therapy outcomes for people with learning disabilities compared with people with no disabilities and people with other disabilities. (3) To understand adaptations to IAPT processes and therapies that may make IAPT services more accessible to people with learning disabilities. [ABSTRACT FROM AUTHOR]

Background: Since adenocarcinoma of the ethmoid sinuses was first described as an occupational disease in the woodworkers of High Wycombe, over the 50 subsequent years there has been a gradual decrease in the numbers to none over the last 12 years. Although this mirrored the decline in local industry, it seems the causative factor was first seen and then disappears over a 50-year period. Methods: A total of 146 cases have been traced historically over this time as well as personal experience of 33 cases; these cases are reviewed and success with a new modality of treatment is discussed. Conclusion: This paper outlines how the disease was initially recognised, both its diagnosis and treatment development. It also describes how both the appearance and disappearance were seemingly caused by changes in manufacturing practice. [ABSTRACT FROM AUTHOR]

In the current ecology of care, social, rather than medical, support is critical in enabling frail older people to live at home. This paper reports findings from a qualitative study about how home care workers (HCWs) support persons with dementia living in the community. Semi-structured qualitative interviews were carried out in England with 14 family care-givers (FCGs) recruited from a single private home care provider. A thematic analysis of the data was undertaken using the constant comparative method. In every instance, it was FCGs who initiated domiciliary care for the person with dementia, highlighting ambiguity about who is the 'client'. Rather than focusing on the HCWs' work in undertaking practical tasks and personal care, respondents prioritised HCWs as companions, providing emotional and social support for their relatives. From an organisational perspective, respondents valued the capacity of the provider to deliver a consistent, personal, reliable and punctual service. These attributes were important in supporting their relative's agency and dignity. Respondents described HCWs engaging in skilled and sensitive communication with clients but considered 'character' and 'innate' caring abilities to be more important than those derived from training. The results highlight the need to acknowledge the family, rather than the individual client, as the functioning unit of care, and to recognise the highly skilled communicative and emotional work undertaken by HCWs. [ABSTRACT FROM AUTHOR]

In north-western varieties of British English the historical process of ng-coalescence that simplified nasal + stop clusters in words like wrong and singer never ran to completion, with surface variation between [ŋ] and [ŋɡ] remaining to this day. This paper presents an empirical study of this synchronic variation, specifically to test predictions made by the life cycle of phonological processes; a diachronic account of /ɡ/-deletion has been proposed under this framework, but crucially the life cycle makes hitherto-untested predictions regarding the synchronic behaviour of (ng) in north-west England. Data from 30 sociolinguistic interviews indicate that these predictions are largely met: internal constraints on the variable are almost entirely accounted for by assuming cyclic application of /ɡ/-deletion across a stratified phonology. There is also evidence of apparent time change in the pre-pausal environment, which is becoming increasingly [ɡ]-favouring contrary to the life cycle's predictions. It is argued that this reflects a separate innovation in the life cycle of (ng), with synchronic variation reflecting two processes: (i) the original deletion, overlaid with (ii) a prosodically-conditioned insertion process. These results have implications for theories of language change and the architecture of grammar and add to a growing body of evidence suggesting that the effect of pause on probabilistic phenomena can be synchronically variable and diachronically unstable. [ABSTRACT FROM AUTHOR]

There has been a renewed call for a revaluing of informal caring in order to counter the way that caring is undervalued, taken for granted and invisible. Travel is one area where a detailed critique of this issue has emerged with the concept of 'mobility of care', however, this concept has only been applied in relation to younger age groups, and our understanding of mobilities of care in later life remains underdeveloped. By 'mobilities of care' we mean journeys made for the purpose of giving and receiving informal care and support. This paper draws on the mobility narratives of 99 older people (aged 55 and above) living in three locations in the North of England who participated in a two-year qualitative longitudinal study that explored the inter-play between mobility, wellbeing and life transitions. We focused on the experience of managing life transitions rather than assume that chronology per se determines wellbeing. Narratives of ageing emphasise the importance of getting out and about, and being socially connected active citizens. Our study demonstrates that for many older people getting out and about is not for leisure or utility purposes but to give support and care. As such, these journeys have a particular significance in the lives of older people and in the construction of roles, meaning and identity in later life. [ABSTRACT FROM AUTHOR]

Drawing on a 2010 analysis of the reform and costs of adult social care commissioned by Downing Street and the UK Department of Health, this paper sets out projected future costs under different reform scenarios, reviews what happened in practice from 2010-19, explores the impact of the growing gap between need and funding, and explores the relationship between future spending and economic growth. In the process, it identifies a 'lost decade' in which policy makers failed to act on the warnings which they received in 2010, draws attention to the disproportionate impact of cuts on older people (compared to services for people of working age) and calls for urgent action before the current system becomes unsustainable. [ABSTRACT FROM AUTHOR]

The benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents' days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents' quality of life improved. [ABSTRACT FROM AUTHOR]

Objective: A variety of paediatric tracheostomy tubes are available. This article reviews the tubes in current use at Great Ormond Street Hospital for Children and Evelina London Children's Hospital. Methods: This paper outlines our current preferences, and the particular indications for different tracheostomy tubes, speaking valves and other attachments. Results: Our preferred types of tubes have undergone significant design changes. This paper also reports further experience with certain tubes that may be useful in particular circumstances. An updated sizing chart is included for reference purposes. Conclusion: The choice of a paediatric tracheostomy tube remains largely determined by individual clinical requirements. Although we still favour a small range of tubes for use in the majority of our patients, there are circumstances in which other varieties are indicated. [ABSTRACT FROM AUTHOR]

The decision to start a new career might seem an unusual one to make in later life. However, England has seen a steady rise in numbers of workers undertaking an apprenticeship in their fifties and sixties, through a government-funded policy initiative opening up training to adults at all stages of the lifecourse. At the same time, in most Western contexts, the amalgamation of ‘older’ and ‘apprentice’ presents a challenge to normative understandings of the ‘right age’ to undertake vocational training. What is it like to make a new start as an older worker? This paper draws on new qualitative research conducted in England with older apprentices, exploring how they found the experience and management of training ‘out of step’. Inspired by Elizabeth Freeman's temporalities approach, our findings reveal how powerful norms of age-normativity routinely structure understandings, experiences and identities of older-age training for both organisations and apprentices. While these norms demand careful negotiation by both apprentices and trainers, if managed successfully older workers gain significant benefits from their training. These findings have resonance not only for England, but for other international contexts considering expanding vocational training into older age. The paper concludes that if adult training schemes are to succeed, some fundamental changes may need to be made to understandings of age and ageing within contemporary workplaces. [ABSTRACT FROM AUTHOR]

Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care 'Improving Access to Psychological Therapies' (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the 'Standardised Assessment of Personality – Abbreviated Scale' (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach. [ABSTRACT FROM AUTHOR]

This paper addresses the theme of mobility in the context of late medieval political thought, more specifically, the rhetoric of royal charters issued in England and the Holy Roman Empire in the fourteenth century. [ABSTRACT FROM AUTHOR]

The contribution of this paper is to analyse statistical data to assess whether homelessness among people who have recently been granted refugee status in England is concentrated amongst particular groups of these refugees. The methodology was quantitative analysis using logistic regression of the Home Office's Survey of New Refugees (SNR), which they carried out in 2005-7. We tested the relative role played by pre-migration demographic factors, post-migration life experience factors, and government immigration policy in accounting for patterns found, and drew on literature to interpret the meaning of our statistical results. Our analysis clearly suggests that refugee and asylum policy contribute to homelessness among newly-recognised refugees. This interpretation is supported by the qualitative evidence from services providing assistance to refugees, and evidence put to the All Party Parliamentary Group on Refugees (2017). Action to address the housing problems of refugees moving on from accommodation provided for asylum seekers should be considered a high policy priority, albeit that associations between homelessness, household size, and age also present intervention opportunities. [ABSTRACT FROM AUTHOR]

Background. Responses to anticipateddiscrimination are common among mental health service users and can have adetrimental impact on their recovery. Since 2009, the Time to Change (TTC) anti-stigma program in England has aimed to improve service users' empowerment, reducing public stigma and discrimination. In this paper, we aim to evaluatewhether service users' awareness of TTC is associated with fewer responses toanticipated discrimination. Methods. We used data collected for the evaluation of TTC from samples of mental health service users interviewed by telephone in annual surveys 2009-2014. Results. Five thousand and nine hundredand twenty-three participants completed the survey, mainly suffering from mooddisorders (depression, 28.4%, n = 1,681) and schizophrenia related disorders(15.4%, n = 915). In 23.2% of cases, participants were aware of any aspects of the TTC program, while participationin TTC was reported by 2.6%. Being aware of the TTC program was notsignificantly associated with responses to anticipated discrimination, except for those participating in the TTC campaign in 2013. Stopping oneself fromapplying for work was significantly associated with experienced discriminationin both finding (p < 0.001) and keeping (p < 0.001) a job. Concealing mental health problems was associated with a general experience of being shunned (p < 0.001). Conclusions. Awareness of a nationalanti-stigma program may not be sufficient to encourage people to seek work/educationor to be open about their illness in situations in which they currentlyanticipate discrimination. There is the need to identify new multi-levelstrategies for challenging anticipated discrimination, even focusing ondifferent target groups. [ABSTRACT FROM AUTHOR]

Each year in the UK there are approximately 250,000 miscarriages, 3,000 stillbirths and 3,000 terminations following a diagnosis of fetal-abnormality. This paper draws from original empirical research into the experience of pregnancy loss and the accompanying decisionmaking processes. A key finding is that there is considerable variation across England in the range of options that are offered for disposal of pregnancy remains and the ways in which information around disposal are communicated. This analysis seeks to outline the key features of what constitutes effective communication in this context, where effective communication is taken to mean that patients are provided with the key information necessary, in an appropriate manner, so that they are fully able to make a decision. A primary source of evidence includes interviews with the bereaved and pregnancy-loss support workers, in order to understand how the options available, and associated necessary procedures, are communicated. In addition, patient information leaflets are also analyzed as they offer an important tool for information delivery at a difficult and emotionally charged time. Following this, an overview is provided of the information that these leaflets should contain, along with guidance on effective presentation of this information. [ABSTRACT FROM AUTHOR]

Over the past decade, provision of cognitive behaviour therapy has expanded massively in the UK, both within the private sector and through the Improving Access to Psychological Therapies (IAPT) programme. Our aim in this study was to explore and compare the brand names adopted by IAPT and private CBT services. We obtained the names of all the IAPT and private services in England and created a word cloud for each sector. There was no significant difference in the proportion of services that adopted a brand name (72% of IAPT services vs 67% of the private services). In those with a brand name, IAPT services were significantly more likely than private services to contain positive words, and to have a theme of togetherness and collaboration. However, private services were more likely to include a psychological therapy in their name and have a theme of efficacy compared with IAPT. The most common keywords in IAPT services were 'talking' and 'thinking'. IAPT services use a variety of euphemisms such as 'talking' for a psychological therapy. There is no theme for 'doing' in the IAPT or private services, despite behavioural interventions being one of the most common therapeutic components. The brand names in IAPT are overwhelmingly positive and convey the hope of a good outcome. They do not include the experience of difficult emotions, such as sadness and fear during therapy. We found just one private service that evoked the history of CBT named after Vic Meyer. Perhaps we will have some Clark and Layard centres in the years to come! Key learning aims: After reading this paper, the reader should: (1) Recognise the importance of a brand name in shaping service user expectations. (2) Understand the differences between how private CBT and IAPT services present themselves to the public. (3) Recognise the omission of words conveying an active 'doing' theme in IAPT and private CBT service names. [ABSTRACT FROM AUTHOR]

This paper investigates the association between accumulated major lifecourse adversities and later-life depressive symptoms among older people in England, both at a single point in time (prevalence) and the onset over time during later life (incidence), using data from the English Longitudinal Study of Ageing. Using retrospective data on the experience of major life adversities from childhood onwards, five latent classes were identified: no/few lifecourse adversities (58.6%), lost relationship (27.0%), chained adversities (2.4%), childhood adversities (6.3%) and war-related adversities (5.7%). Older people who had experienced 'chained adversities', 'childhood adversities' and 'a lost relationship' had higher odds of presenting current depressive symptoms in 2006, even after controlling for socio-demographic characteristics, health-risk behaviours and social resources. Longitudinal analysis indicated that amongst respondents who were clear of depression in 2006, those older people who had experienced childhood adversities, a lost relationship and war-related adversities experienced a higher risk of having a new case of depressive symptoms. Results further indicate that women's mental health in later life is more sensitive to earlier life adversities than men's. The study shows that intervention earlier in the lifecourse may have benefits for the individual both contemporaneously and over the longer term. [ABSTRACT FROM AUTHOR]

This paper examines the factors affecting the receipt of informal care among older people in China. It uses the second wave data of the China Health and Retirement Longitudinal Survey, which collected ageing and health-related information on a nationally representative sample of 8,906 older people aged 60 and over in 2013. Apart from the factors that have been examined in the contexts of developed countries, the paper further investigates two factors specific to Chinese society: rural–urban residence and regular financial assistance from children. Based on binary and multinomial logit regression analyses, the research findings are threefold: the determinants of receiving informal care differ remarkably according to the sources of care; disability and living arrangements are the most important determinants; rural–urban residence plays a vital role in the Chinese context, but regular financial assistance from children makes little difference. It is estimated that 53 million older people are receiving informal care each year, a figure equivalent to the entire population of England. With continuous population ageing, Chinese society will face huge pressure to meet the demand for social care among older people in the future. The Chinese government needs to build a well-rounded welfare system that tackles this challenge from multiple dimensions. The formal care services should aim to complement informal care in the short run and reduce inequality in social care in the long run. [ABSTRACT FROM AUTHOR]

The last year has seen a revolt against the recommendations of the Zellick Report (1994) in England and Wales, and pressure on universities worldwide to bring serious criminal conduct within their own disciplinary structures. This paper examines the reasons why the Zellick Report advised against this, and why higher-education institutions have now turned their back on a number of its recommendations. Factors including student pressure and concerns about low conviction rates for sexual offences in the criminal courts have been cited, but this paper argues that universities will struggle to create a disciplinary system that is fair to both those who are accused of such offences and those who have been victims of them. A recent Universities UK report has reversed the Zellick guidance that conduct amounting to a serious criminal offence should never be pursued under university disciplinary structures. Drawing on both authors' experiences as practitioners, and using the first author's experience of university disciplinary matters as a case-study, this paper reviews the practical problems of bringing such serious conduct under university disciplinary structures, focusing particularly on the intersection of criminal and internal disciplinary proceedings. It concludes by suggesting possible ways of ameliorating these. [ABSTRACT FROM AUTHOR]

The social risk literature examines the extent to which states have provided social protection against the ‘old’ social risks of the post-war era and the ‘new’ social risks affecting post-industrial capitalist states. In this paper the contingency of the provision of informal care to people aged 65 and over is discussed. The paper deconstructs the concept of social risk to determine the characteristics and processes which contribute to states recognising specific contingencies as social risks which require social protection. This conceptualisation is applied to make the case that care-related risks associated with the informal care of older people should be recognised and treated as social risks by states. Data from a qualitative study of the English care policy system provide empirical evidence that informal care-related risks are recognised, but not treated, as social risks in England. The findings reveal informal carers, and the older people they care for, receive inadequate and inconsistent statutory protection against the poverty and welfare risks they face. Furthermore the design and operationalisation of the English care policy system generates risks for care relationships. [ABSTRACT FROM PUBLISHER]

This paper derives from a study of community food aid in a multi-ethnic, multi-faith city in the North of England. The paper begins to make sense of the diversity of types of food insecurity assistance, examines the potential exclusion of certain groups from receipt of food aid, and explores the relationship between food aid providers and the state. Faith-based food aid is common in the case study area, particularly among food bank provision to the most ‘destitute’ clients. While food aid is adopting service responsibilities previously borne by the state, this does not imply an extension of the ‘shadow state’. Rather, it appears reflective of a pre-welfare state system of food distribution, supported by religious institutions and individual/business philanthropy, but adapted to be consistent with elements of the ‘Big Society’ narrative. Most faith-based providers are Christian. There is little Muslim provision of (or utilisation of) food aid, despite the local demographic context. This raises concerns as to the unintentional exclusion of ethnic and religious groups, which we discuss in the concluding sections. [ABSTRACT FROM AUTHOR]

The mouth may be presented and understood in different ways, be subject to judgement by others and, as we age, may intrude on everyday life due to problems that affect oral health. However, research that considers older people's experiences concerning their mouths and teeth is limited. This paper reports on qualitative research with 43 people in England and Scotland, aged 65–91, exploring the significance of the mouth over the lifecourse. It uses the concept of 'mouth talk' to explore narratives of maintaining, losing and replacing teeth. Participants engaged in 'mouth talk' to downplay the impact of the mouth, demonstrate socially appropriate ageing, and distance themselves from 'real' old age by retaining a moral identity and sense of self. They also found means to challenge dominant discourses of ageing in how they spoke about missing teeth. Referring to Leder's notion of 'dys-appearance' and Gilleard and Higgs' work on the social imaginary of the fourth age, the study illustrates the ways in which 'mouth talk' can contribute to sustaining a sense of self in later life, presenting the ageing mouth, with and without teeth, as an absent presence. It also argues for the importance of listening to stories of the mouth in order to expand understanding of people's approaches to oral health in older age. [ABSTRACT FROM AUTHOR]

As a response to the ageing population, the United Kingdom (UK) government, like many others, has increased the State Pension Age. This has involved equalising women's State Pension Age with men's, raising it from 60 to 65, with further increases already underway. It has been argued that a key issue with how this change has been implemented is the lack of notice the government gave to the women affected, impacting on their ability to plan for retirement. So far, there has been very little research exploring inequalities in awareness of these developments and, in particular, considering whether women of particular socio-economic backgrounds are less likely to know about the changes. This has implications for potentially further widening inequalities in old age. In this paper we analyse data from the English Longitudinal Study of Ageing. We consider the role of cognitive ability in mediating the relationship between socio-economic background and awareness, given recent debates on deficiencies in financial literacy. We find that socio-economic inequalities exist, especially with respect to labour force status, occupation and education. We also find that cognitive ability, especially numeracy, mediates a sizeable proportion of the relationship. These findings have important implications in terms of implementing future policy changes and awareness campaigns to help mitigate the possibility that they will further entrench inequalities in older age. [ABSTRACT FROM AUTHOR]

It is widely recognised that a diagnosis of a long-term physical health condition (LTC) is likely to have a significant impact on a person's mental health. This is highlighted in the Five Year Forward View for Mental Health (NHS England, 2016) where significant numbers of patients projected to be seen through the expansion of Improving Access to Psychological Therapies (IAPT) services are to come from within the LTC community. IAPT services offer evidence-based therapeutic interventions for common mental health issues – anxiety disorders and depression. The South East Staffordshire IAPT services have developed an integrated pathway as a Wave 2 site for the delivery of cognitive behavioural therapy (CBT) adaptations for LTC. The main themes outlined in this paper focus on the innovations and service developments of IAPT-LTC including: the importance of engagement between mental health and medical healthcare professionals, identifying the key professionals in medical healthcare to enhance engagement, extended training for clinicians with in-house continued professional development, as an extension to the National IAPT-approved top-up training for LTC, and developments in clinical supervision structures and practice, along with future developments in the field of IAPT-LTC. These themes have direct relevance to CBT practitioners working within the LTC community in IAPT services. The four contrasting case studies demonstrate how the application of CBT can successfully be adapted to condition related beliefs and behaviours, despite the complexity of the medical condition. Findings show how integrated services and engaging with medical healthcare professionals had profound benefits for the patients, IAPT therapists and medical healthcare professionals. Key learning aims: (1) The good practice points in the development of the IAPT-LTC pathway within South East Staffordshire IAPT services. (2) The successful design and implementation of the IAPT-LTC pathway within South East Staffordshire IAPT services. (3) The key considerations of the interaction for patients between their physical and mental health symptoms. (4) The application of CBT adaptations for people with complex LTCs can be effective in improving psychological wellbeing and physical condition management. [ABSTRACT FROM AUTHOR]

Although women's appearance is theorised as being central to their identity and social currency, much prior research has argued that as women age, other aspects of their lives assume a higher priority than their appearance. Nevertheless, they continue to invest time in appearance practices. In undertaking these various appearance practices, older women have to negotiate a range of conflicting social norms of age-appropriate appearance, such as managing the balancing act between 'letting themselves go', on the one hand, and looking like 'mutton dressed as lamb', on the other. This paper contributes to the growing literature on older women's attitudes to their appearance and related practices. Drawing on data from a two-year research project in a hair-salon catering primarily for older clients, I examine the question of the importance to women of their appearance through the lens of their hair-care practices. Focusing on a group of nine female clients aged 55–90 in a small hair-salon in southern England, I show how participants in their talk and embodied presentation display shifting orientations of investment/interest (or lack of interest) in their appearance. Comparing participants' appearance practices , with their talk in two sequential environments in which a possible interest in appearance is made particularly salient, I argue that these shifting orientations reveal participants' subtle negotiation of competing social norms of appearance for older women. [ABSTRACT FROM AUTHOR]

This paper sets out the distinctive harm caused and wrong done to child pornography victims. It presents a paradigm of reparation within a restorative justice framework that explains the significance of material reparation for these victims. The paper demonstrates that because of the particular nature of child pornography offences and the harms and wrongs occasioned, existing avenues for legal redress in England and Wales and the USA are generally inadequate and ill-fitting, and that a new mechanism for effecting suitable reparation is required. It concludes by sketching a new mode of restorative justice for victims of child pornography, emphasising significant matters that must be addressed alongside financial redress in order to facilitate victims' restoration. [ABSTRACT FROM AUTHOR]

This paper provides new empirical evidence about English andWelsh charities operating internationally. It answers basic questions unaddressed in existing work: how many charities work overseas, and how has this number changed over time? In which countries do they operate, andwhat underlies these geographical patterns? It makes use of a unique administrative dataset which records every country in which each charity operates. The results show a sizeable increase in the number of charities working overseas since the mid-1990s. They show that charities are much more likely to work in countries with colonial and linguistic ties to the UK, and less likely to work in countries with high levels of instability or corruption. This considerable geographical unevenness, even after controlling for countries' population size and poverty, illustrates the importance of supply-side theories and of institutional factors to an understanding of international voluntary activity. The paper also serves to provide a new perspective on international charitable operation: while it is the large development charities that are household names, the results reveal the extent of small-scale 'grassroots' registered charitable activity that links people and places internationally, and the extent of activity in 'developed' as well as 'developing' country contexts. [ABSTRACT FROM AUTHOR]

Several abstracts are presented from the Otology Section Meetings of the Royal Society of Medicine on topics including validity of the Visible Ear Simulator as a tool for temporal bone dissection; and comparison of cervical and ocular vestibular-evoked myogenic potentials in patients with Ménière's disease.