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Effective integration of research within healthcare organisations is recognised to improve outcomes. A research strategy within a hospital Trust in South West England was revised, following the launch of a national Chief Nursing Officer (CNO) strategy that promotes research engagement and activity. The aim was to develop, implement and evaluate this revised strategic plan for research. High-level engagement within the organisation was established and previous initiatives evaluated. A 6-year plan with 2-year targets was defined and evaluated at year end. The four pillars of the CNO strategy were central to the revised strategy, underpinned by digital innovation. Evaluation of the earlier strategy indicated excellent engagement with the Chief Nurse Research Fellow initiative and the Clinical Academic Network. The 'Embedding Research In Care' (ERIC) unit was reconfigured to an ERIC model, which aided question generation and project development. Year one objectives were achieved within the revised plan. Implementing a research strategy within an organisation requires a cultural shift and a long-term vision is required with measurable objectives. The team demonstrated significant progress through high-level leadership, mentoring and cross-professional collaboration. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

This paper assesses how strategic planning for nature can be improved for England's built and natural environment using mainstreaming and landscape-scale concepts. Whilst both concepts feature in academic literature, there has been limited attention on their role as catalytic agents for strategic planning. Addressing this gap, evidence is used from two stakeholder workshops involving 62 senior policy experts managing a range of operational and hypothetical strategic spatial planning challenges. The results reveal a significantly weakened strategic planning arena characterised by policy disintegration, short termism and uncertainty. Key findings highlight the fallacy of pursuing strategic planning for nature in isolation from wider policy integration fusing environmental, economic and social components from the outset. Current barriers to progress include institutional inertia, technocratic vocabularies and neoliberalist priorities exacerbated by a weak underlying theory. Conversely opportunities for mainstreaming processes may help knowledge generation and exchange within transdisciplinary partnerships, whilst landscape scale thinking can improve understanding of issues using natures inherent geometry transforming processes and outcomes. The paper recommends the adoption of strategic planning pathways using mainstreaming and landscape-scale approaches working in tandem. Whilst focused on the English context, our findings are transferable to other planning systems in the Global North, especially those championing neoliberal market led policies. [ABSTRACT FROM AUTHOR]

Context: A key task for countries around the world facing the COVID-19 pandemic was to achieve high vaccination coverage of the population. To overcome "vaccination inertia," governments adopted a variety of policy instruments. These instruments can be placed along a "ladder of intrusiveness" based on their degree of constraint of individual freedoms. The aim of this study is to investigate how the governments of three European countries moved along the ladder of intrusiveness and how the choice of policy instruments was influenced by contextual factors. Methods: The study draws on secondary data sources, including academic and gray literature, policy documents, and opinion polls, over an observation period from December 2020 to summer 2022. The study employs inductive logic to analyze data and identify the factors explaining similarities and differences across England, Germany, and Italy. Findings: The study identifies similarities and differences in how the three countries advanced along the ladder of intrusiveness. Contextual factors such as policy legacy, social acceptability, and ideological orientation contribute to explain the observations. Conclusions: Country-specific contextual factors play an important role in understanding the choice of policy instruments adopted by the three countries. Policy makers should carefully consider these factors when planning immunization strategies. [ABSTRACT FROM AUTHOR]

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages. [ABSTRACT FROM AUTHOR]

Introduction: Co‐production with communities is increasingly seen as best practice that can improve the quality, relevance and effectiveness of research and service delivery. Despite this promising position, there remains uncertainty around definitions of co‐production and how to operationalize it. The current paper describes the development of a co‐production strategy to guide the work of the ActEarly multistakeholder preventative research programme to improve children's health in Bradford and Tower Hamlets, UK. Methods: The strategy used Appreciative Inquiry (AI), an approach following a five‐step iterative process: to define (Step 1) scope and guide progress; to discover (Step 2) key issues through seven focus groups (N = 36) and eight in‐depth interviews with key stakeholders representing community groups, and the voluntary and statutory sectors; to dream (Step 3) best practice through two workshops with AI participants to review findings; to design (Step 4) a co‐production strategy building on AI findings and to deliver (Step 5) the practical guidance in the strategy. Results: Nine principles for how to do co‐production well were identified: power should be shared; embrace a wide range of perspectives and skills; respect and value the lived experience; benefits should be for all involved parties; go to communities and do not expect them to come to you; work flexibly; avoid jargon and ensure availability of the right information; relationships should be built for the long‐term; co‐production activities should be adequately resourced. These principles were based on three underlying values of equality, reciprocity and agency. Conclusion: The empirical insights of the paper highlight the crucial importance of adequate resources and infrastructure to deliver effective co‐production. This documentation of one approach to operationalizing co‐production serves to avert any misappropriations of the term 'co‐production' by listening to service users, stakeholders and other relevant groups, to develop trust and long‐term relationships, and build on the learning that already exists amongst such groups. Patient or Public Contribution: The work was overseen by a steering group (N = 17) of individuals, both professional and members of the public with experience in undertaking co‐production, and/or with some knowledge of the context of the two ActEarly field sites, who provided regular oversight and feedback on the AI process. [ABSTRACT FROM AUTHOR]

SUMMARY: Demands on health and social care are growing in quantity and complexity, with resources and staffing not projected to match this. The landmark NHS Long Term Plan calls for services in England to be delivered differently through integrated care systems (ICSs) that will better join commissioners and providers, and health and social care. The scale of these changes is immense, and the detail can feel confusing. However, they are important and will affect all clinicians in the public service. This three-part series provides a primer on integrated care, explaining why it is happening, how services are changing and why clinicians should get involved. In this first article we focus on the changing demographics, and the workforce and financial resources required to address these. [ABSTRACT FROM AUTHOR]

The Green Belt is one of the most widely known and popular regional growth management policies having been adopted around the world. Drawing upon the regional spatial imaginary and historical institutionalist literature alongside a case study of the West Midlands, this paper conceptualizes the Green Belt as an enduring, regionalizing concept in the spatial vision of planners and professional campaigners. It underscores the continuing importance of planning history and critical junctures in 'framing' the perspectives and aspirations of practicing planners regarding strategic planning. The paper charts the emergence, embedding, and adaptability of the Green Belt as an institution before exploring how strategic vision has continued to be vitally important to planners and campaigners despite the abolition of statutory strategic planning in England in 2010. [ABSTRACT FROM AUTHOR]

Simple Summary: A risk-stratified approach to breast cancer screening has gained international interest as a mechanism to better balance the benefits, harms and costs of screening programmes. The aim of our agenda setting meeting was to identify key uncertainties to resolve in order to implement a risk-stratified breast screening programme within England. Findings from a 5-year programme of research assessing the feasibility of such an approach in England were presented before individual discussion groups and an open plenary session regarding what preparation needs to take place. Key findings highlight the need to further develop risk modelling to ensure equity of access to breast cancer risk assessment and ensure a risk-stratified programme is cost-effective. Other issues highlighted related to capacity and capability of the health services to offer an integrated risk assessment pathway that is accessible. Attendees identified ways in which risk-stratification could be implemented to minimise inequity of access to screening. It is now possible to accurately assess breast cancer risk at routine NHS Breast Screening Programme (NHSBSP) appointments, provide risk feedback and offer risk management strategies to women at higher risk. These strategies include National Institute for Health and Care Excellence (NICE) approved additional breast screening and risk-reducing medication. However, the NHSBSP invites nearly all women three-yearly, regardless of risk. In March 2022, a one-day agenda setting meeting took place in Manchester to discuss the feasibility and desirability of implementation of risk-stratified screening in the NHSBSP. Fifty-eight individuals participated (38 face-to-face, 20 virtual) with relevant expertise from academic, clinical and/or policy-making perspectives. Key findings were presented from the PROCAS2 NIHR programme grant regarding feasibility of risk-stratified screening in the NHSBSP. Participants discussed key uncertainties in seven groups, followed by a plenary session. Discussions were audio-recorded and thematically analysed to produce descriptive themes. Five themes were developed: (i) risk and health economic modelling; (ii) health inequalities and communication with women; (iii); extending screening intervals for low-risk women; (iv) integration with existing NHSBSP; and (v) potential new service models. Most attendees expected some form of risk-stratified breast screening to be implemented in England and collectively identified key issues to be resolved to facilitate this. [ABSTRACT FROM AUTHOR]

In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non‐statutory home‐care providers (for‐profit, not‐for‐profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home‐care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi‐structured telephone interviews with 20 managers of for‐profit home‐care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home‐care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time‐consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal–steward relationships in contracting. [ABSTRACT FROM AUTHOR]

The article presents an editorial focuses on the historical and current landscape of adult social care in England, emphasizing the need for collaboration between health and social services to address persistent challenges in access, staffing, and quality of care. Topics include the evolution of social care policies, the current workforce situation, and ongoing challenges such as delayed access to care and discharge delays contributing to inadequate capacity and quality of care.

The article supports the Association for Simulated Practice in Healthcare (ASPiH) Standards 2023 as a framework for integrating simulation in healthcare education. Benefits offered by the ASPiH Standards for nursing students include quality assurance of simulated practice learnings, practical real-world scenarios recreated in a controlled setting, hands-on experience in managing patient care scenarios, interprofessional education, and handling of ethical dilemmas and emotional situations.

The article focuses on the possibility of Nursing Associates (NAs) undertaking travel health responsibilities if properly trained, addressing concerns about their role under current legislation and suggesting the Competency Assessment Tool for evaluation. It discusses the release of a new NHS vaccination strategy aimed at integrating all vaccination programs to protect communities, highlighting the need for innovative approaches in vaccine delivery.

Strategic spatial planning (SSP) has been a key planning practice supporting spatial transformation globally. However, designing and implementing strategic spatial plans is a complex task. The process involves prioritizing planning intentions, establishing funding mechanisms and structuring governance settings, which take shape within power configurations. It is within this complexity that a participatory and integrative planning approach assumes increasing importance when addressing, strategically, societal challenges such as spatial injustice. Furthermore, a consolidated planning practice – that is the experiences in dealing with SSP are thought to influence how strategic plans are prepared and executed. Bearing in mind the influential role of preceding experiences in SSP processes as well as of participation, project promotion and policy integration, this paper synthesizes the results of a literature review reflecting three decades of SSP (1990–2020) in England. England has a well-defined history of engagements with SSP. The purpose is to discuss lessons learned from looking back 30 years and debate suggestions for how to design future SSP that account for public and private interests and align cross-sectoral policies. To overcome democratic accountability constraints and steering resource management effectively, this review pleas for more cooperative central–local relationships in shaping future SSP processes in England and beyond. [ABSTRACT FROM AUTHOR]

The long-awaited NHS workforce plan, now published years after it was promised, has been met with scepticism over how its commitments will be delivered. [ABSTRACT FROM AUTHOR]

Purpose: Farm businesses in England are under pressure to intensify production sustainably while managing costs and meeting market demands. Commodity prices and support from Common Agricultural Policy (CAP) payments are important determinants of profitability. With the United Kingdom (UK) leaving the European Union (EU), revised policy will see farming more exposed to fluctuating commodity prices and financial support from Government more focused on encouraging environmental land management. The research reported here, investigated whether business management practices of farmers influences financial performance, and how policy could be tailored to better meet the needs of farm businesses. Design/methodology/approach: Regression models were estimated for 862 Cereals, Dairy and Livestock farms in England using official data for 2011–2012, in order to assess whether different farm characteristics, business management practices (identified from a systematic review of 102 studies), knowledge acquisition indicators and manager experience had an effect on four different financial performance ratios. The financial performance of the top 25% of the sample was also compared to the bottom 25% in terms of use of business management practices. Findings: The results show that business planning and benchmarking had a positive, statistically significant, effect on financial performance, as do business size and knowledge acquisition, albeit to a lesser extent. Originality/value: The research reported here is the most extensive examination, to date, of the impact of management practices on the financial performance of farms. Thus, it sends strong policy recommendations. [ABSTRACT FROM AUTHOR]

COVID-19 created a substantial set of challenges for health communication practitioners in the process of planning, implementing, and evaluating entertainment-education (EE) campaigns. EE is a theory and evidence-based communication strategy that employs entertainment media for educational messaging. Here, we briefly review EE campaigns in response to previous health emergencies and present three cases of EE responses to the COVID-19 pandemic from leading global organizations (PCI Media, BBC Media Action, and Sesame Workshop). Responses ranged from adaptation and re-distribution of existing content to creating new content under social-distancing restrictions and utilizing transmedia. These cases demonstrate that EE initiatives responding to future pandemics may be well served by starting with existing infrastructure to quickly build capacity, support, and trust; working with partners to tailor programs to the local context; and continuing to focus on good storytelling while simultaneously considering evolving media formats and theory. [ABSTRACT FROM AUTHOR]

The Green Belt in England is probably the most longstanding and internationally recognised Urban Growth Boundary (UBG). However, developers, think tanks and academics often accuse UGB's of being the leading cause of the housing affordability problems around the world and articulate an alternative vision of Transit-Oriented Development (TOD). This paper, based upon a regional case study of the West Midlands and 74 interviews with planners and planning stakeholders, argues that the debate around TOD in the Green Belt needs to be more cognisant of regional geographical variation in public transport provision. Moreover, drawing upon the views of planners who play a key a role in allocating land for development, the paper underlines that decisions regarding TOD need to made strategically as reflecting the policy's purpose as a regional growth management policy. Reflecting on the broader academic literature, it highlights the need for greater strategic integration of transport and land-use planning alongside reviving strategic planning to evaluate various spatial blueprints for urban growth management. The paper has broader relevance to international debates about the feasibility and potential of TOD, especially in addressing housing affordability problems around the world. [ABSTRACT FROM AUTHOR]

The article offers information on the historical journey of the NHS in England, highlighting its growth and expansion over 75 years. It discusses current challenges in the healthcare sector, such as nursing workforce shortages and the impact on patient care, emphasizing the need for collaborative efforts to address these issues and enhance the wellbeing of healthcare professionals.

Policy PointsStrategically purchasing health care has been and continues to be a popular policy idea around the world.Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing.Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. Context: Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. Methods: We conducted three in‐depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. Findings: No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. Conclusions: Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create. [ABSTRACT FROM AUTHOR]

The revocation of the regional tier of planning by the UK Coalition Government in 2010 removed the established framework of strategic planning in England. Using a case study of green infrastructure (GI), this paper examines whether revocation has negatively impacted the development of environmental, and specifically GI policies and practice. It questions if changing government policy narratives have hindered advocacy and subsequently the delivery of GI and the extent to which it has been able to position itself as a mainstream approach in planning. Using the development of the RSS in England, and the North-East and East of England sub-regional GI strategies (areas of significant policy development), as case studies, the paper presents an ex-ante evaluation prior to revocation of the evolution of GI policy at a regional scale, alongside an ex-post assessment (2011–2015) of its continued growth within sub-regional policies. The paper concludes that whilst RSSs provided a promotional forum, that revocation has not negatively impacted upon GI development, as its advocates have facilitated a supportive policy-implementation environment which has led to the development of more integrated approaches in planning praxis. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to explore the nature of clinical commissioning groups (CCGs) in England as membership organizations. Utilizing the concept of meta-organization as a lens, we discuss the impact that this organizational form might have on CCGs' ability to become 'strategic commissioners'. Methods: We used a longitudinal qualitative approach to explore the adoption and implementation of primary care co-commissioning. The study was undertaken between May 2015 and June 2017 and included interviews with senior policy makers, analysis of policy documents, two telephone surveys, and case studies in four CCGs nationally. Results: CCGs operate as membership organizations with closed boundary and low stratification, whereby a consensus or majority needs to be reached by members when activities impact on membership or the CCG's constitution. While CCGs should move towards a more strategic commissioning role that is focused on local priorities agreed by their members, they are faced with a complex system of accountabilities and responsibilities, which makes this difficult to achieve. Conclusions: The nature of CCGs as membership-based meta-organizations has the potential to both help and hinder CCGs in becoming strategic commissioners. The complexities in accountability and governance that the membership approach introduces, and the potential difficulties that CCGs face with competing meta-organizations, raises questions about the future of CCGs as membership organizations. [ABSTRACT FROM AUTHOR]

In this article we address scalar issues of power in planning. In the context of the reengineering of governance, including the promotion of localism in England, we focus on local actors' beliefs in the extent of their power (de facto and de jure) over development decisions pertaining to their jurisdiction, on how misreadings arise and the consequences thereof. Our intervention highlights the extent and cost of ambiguity in England's discretionary planning system and asks whether and how this should be moderated. [ABSTRACT FROM AUTHOR]

This article provides a contribution to our understanding of the knowledges and strategies developed by people living with chronic illnesses, based on an empirical study with this population in England and Portugal. The article begins by mapping out the debates in disability studies which have focused on embodiment. It continues by arguing that disabled people constantly have to negotiate codes about the body based on normative notions of the body, which I term normative corporality. The main themes arising from participants' accounts are then identified and discussed. The article ends by arguing that the knowledges and strategies developed by disabled people are often not noticed or are devalued as we tend to value knowledges of the body that come from established systems of knowledge, or from bodies our society deem normative. Thus, disabled people's knowledges can be conceptualized as subjugated knowledges. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to assess the health care system impacts associated with the December 2013 east coast flooding in Boston, Lincolnshire, in order to gain an insight into the capacity of the health care sector to respond to high-impact weather. Methods: Semistructured interviews were held with regional strategic decision makers and local service managers within 1 km of the recorded flood outline to ascertain their experiences, views and reflections concerning the event and its associated health impacts and disruption to health care services. A snowballing sampling technique was used to ensure the study had participants across a broad range of expertise. Interviews were recorded and transcribed verbatim, and data analysis was preformed using NVivo (v10) to apply a thematic coding and develop a framework of ideas. Results: The results of this case study provide a vital insight into the health care disruption caused by flooding. All sectors of the health care system suffered disruption, which placed a strain on the whole system and reduced the capacity of the sector to respond to the health consequences of flooding and delivering routine health care. The formal recovery phase in Lincolnshire was stood-down on 4th February 2014. The results of this work indicate limitations in preparedness of the health care system for the reasonable worse-case scenario for an east coast surge event. Conclusions: The health care sector appears to have limited capacity to respond to weather-related impacts and is therefore unprepared for the risks associated with a future changing climate. Further work is required to ensure that the health care system continues to review and learn from such events to increase climate resilience. [ABSTRACT FROM AUTHOR]

Objective To assess the cost-effectiveness of strategies to increase cervical cancer screening uptake at first invitation (STRATEGIC trial). Methods We performed an economic analysis alongside the STRATEGIC trial, comparing each of seven novel interventions for improving cervical screening uptake with control general practices in Greater Manchester and Grampian (United Kingdom). A template was developed to measure the intervention costs. Trial estimates of screening uptake were combined with data from the literature to estimate healthcare costs of each intervention. The added lifetime costs and quality adjusted life years (QALYs) of attending cervical screening were estimated by a systematic literature review, with relevant results pooled and weighted by study quality. Trial results and estimated lifetime costs and benefits of screening were then combined in a decision analytic model, giving an incremental cost per QALY gained for each intervention. Uncertainty was addressed in probabilistic and univariate sensitivity analyses. Results Intervention costs per screening round per woman attending varied from about £1.20 (2014 UK) for the nurse navigator intervention to £62 for the unrequested HPV self-sampler kit. The meta-analysis revealed a lifetime discounted benefit from screening of 0.043 QALYs per woman attending, at an additional lifetime discounted cost of £234. The incremental cost per QALY gained in all interventions was below £13,000. Probabilistic sensitivity analyses suggested that only unrequested self-sampling and timed appointments have a high probability of being cost-effective. Conclusions Unrequested self-sampling and timed appointments are likely to be cost-effective interventions. Further research is required on the duration of effects and on implementing combinations of interventions. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis, and to address the challenge of change, exploring the necessary components beyond an action plan to ensure that findings and recommendations are embedded in policy and practice.Design/methodology/approach Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. The repetitive nature of the findings prompts questions about how to embed policy and practice change, to ensure impactful use of learning from SARs. A framework for taking forward an action plan derived from an SAR findings and recommendations is presented.Findings Familiar, even repetitive findings emerge once again from the thematic analysis. This level of analysis enables an understanding of both local geography and the national legal, policy and financial climate within which it sits. Such learning is valuable in itself, contributing to the evidence base of what good practice with adults who self-neglect looks like. However, to avoid the accusation that lessons are not learned, something more than a straightforward action plan to implement the recommendations is necessary. A framework is conceptualised for a strategic and longer-term approach to embedding policy and practice change.Research limitations/implications There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here enables conclusions to be reached about issues to address locally and nationally to transform adult safeguarding policy and practice.Practical implications Answering the question “how to create sustainable change” is a significant challenge for SARs. A framework is presented here, drawn from research on change management and learning from the review process itself. The critique of serious case reviews challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.Originality/value The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of following up SARs by using the findings and recommendations systematically within a framework designed to embed change in policy and practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to share how the maturing value and impact model at The University of Sunderland is enabling the author to generate evidence and articulate the insights. The author draws from that evidence to inform and underpin the strategic service planning, resourcing and reporting.Design/methodology/approach The author will demonstrate how impactful articulation of these insights through data visualisation is enabling the author to employ thought leadership in the relationship management with stakeholders by increasing their understanding of the benefit of engagement with the service offers and demonstrating value for money and the value and impact of the role in achieving institutional objectives. The paper will give an overview of the key techniques of the model and will then demonstrate its practical applications using the following examples: how the model is underpinning the approaches to thought leadership in relationship management by enabling the author to effectively generate and articulate evidence to inform strategic faculty action plans; how the model has enabled the authors to develop a new graphical approach to annual reporting. By combining the variety of data sets generated by the model, the author is able to articulate the outputs and impacts of cross-service holistic service offers and clearly demonstrate how institutional strategic objectives are fulfilled.Findings The author will discuss the key findings including: the importance of embedding the model at the heart of the service culture – both in terms of involving staff in data generation and of developing an evidence-based culture of service planning; the benefit of meaningful data, analysis and insights in helping to inform and underpin strategic conversations and relationship management; the transferability of the model across service settings; the agility of a snapshot approach in enabling the authors to evidence and inform current strategic service priorities; the impact of a “rounded narrative” technique in articulating powerful human insights which demonstrate engagement, impact and value; and the importance of creative data-visualisation techniques in communicating the insights for maximum impact with the customers and stakeholders.Research limitations/implications This case study demonstrates the approach taken to fulfil a specific strategic need at one UK HE institution. Therefore, the readers are encouraged to consider the approach within that context.Originality/value This paper shares how a strategic approach to capturing and communicating value and impact evidence can contribute to thought leadership in articulating library impact. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to share the ways in which student and learning support at the University of Sunderland has embedded and matured a new outcome-centered performance model – the Quality Model – in order to create an agile evidence-base of value, outcome and impact evidence. The authors will also share how, having established the fundamental principles regarding value and impact capture in our library setting, the concepts and approaches have also been developed and applied successfully within the context of multi-converged service delivery across the wider student and learning support service, using the AMOSSHE Value and Impact Toolkit.Design/methodology/approach The authors’ approach will be illustrated with two case studies, the first focusing on the university library services and the second on the student counseling service.Findings The findings will reveal that by establishing an outcome-focused model, the authors have been able to apply it across a converged service in order to generate the evidence required to articulate the value and impact of our key service objectives.Originality/value As a performance approach, the Quality Model is an original concept in that it is a self-formed model designed to meet the strategic needs of the University of Sunderland. It differs from many performance models in that it is founded on a holistic approach to service culture and customer-relationship management and is based upon strategic marketing principles. The AMOSSHE Toolkit is a pre-existing toolkit which is fully referenced in the paper. The Quality Model and AMOSSHE Toolkit are of particular relevance as many higher education services are increasingly challenged to demonstrate their value and impact and the outcomes their services deliver. This calls for a strategic approach to managing qualitative evidence. Therefore, although bespoke, the approach is transferable to the strategic priorities of other HE settings. [ABSTRACT FROM AUTHOR]

The present paper adopts a social identity perspective to examine the relationship between community-based identification and well-being, resilience and willingness to pay back in the context of urban regeneration. A sample of 104 residents across five deprived urban areas in the southwest of England that have recently undergone or are about to undergo regeneration projects completed a survey. The results demonstrate that areas where a more community-centred, bottom-up, approach to regeneration was taken (i.e., 'culture-led') showed higher levels of community cohesion than areas where the community dynamics were ignored (i.e., a 'top-down' approach to regeneration). Increased community identification was linked to greater perceived social support, community-esteem, personal self-esteem and self-efficacy. These psychological processes were, in turn, linked to increased resilience and well-being, as well as a stronger willingness to pay back to the community. The results are consistent with the social identity approach. Implications for urban regeneration strategies are discussed. [ABSTRACT FROM AUTHOR]

Vascular access is an important component of health care but is not without associated risks, some of which can be life-threatening. The Vessel Health and Preservation (VHP) framework was developed with the intention of providing frontline staff with a resource to assist in assessing and selecting the best vascular access device to meet individual patient needs and to preserve veins for future use. This article examines the impact of the introduction of the framework into a haematology ward in an acute hospital in the North West of England during a 3-month pilot study. The results indicate that the VHP framework gave nursing staff more autonomy to choose the appropriate vascular access device for their patients and improved staff knowledge around pH and osmolality of intravenous drugs. However it is clear that more in-depth evaluations need to be conducted to assess the impact of VHP on patient care and outcomes. [ABSTRACT FROM AUTHOR]

Background: Internationally, there has been increasing focus on creating health research systems. This article aims to investigate the challenges of implementing apparently simple strategies to support the development of a health research system. We focus on a case study of an English National Health Service Hospital Trust that sought to implement the national recommendation that health organisations should introduce a statement about research on all patient admission letters.Methods: We apply core concepts from complexity theory to the case study and undertake a documentary analysis of the email dialogue between staff involved in implementing this initiative.Results: The process of implementing a research statement in patient admission letters in one clinical service took 1 year and 21 days. The length of time needed was influenced firstly by adaptive self-organisation, underpinned by competing interests. Secondly, it was influenced by the relationship between systems, rather than simply being a product of issues within those systems. The relationship between the health system and the research system was weaker than might have been expected. Responsibilities were unclear, leading to confusion and delayed action.Conclusions: Conventional ways of thinking about organisations suggest that change happens when leaders and managers change the strategic vision, structure or procedures in an organisation and then persuade others to rationally implement the strategy. However, health research systems are complex adaptive systems characterised by high levels of unpredictability due to self-organisation and systemic interactions, which give rise to 'emergent' properties. We argue for the need to study how micro-processes of organisational dynamics may give rise to macro patterns of behaviour and strategic organisational direction and for the use of systems approaches to investigate the emergent properties of health research systems. [ABSTRACT FROM AUTHOR]

Debates have persisted about the character of the East–West population flows that followed the EU expansions. Some of the discussions surround the extent to which the mobility has been temporal and hence how likely these migrants are to settle permanently or to stay for long periods in host countries. This paper enhances the understanding of such issues through examining survey data on 700 Polish recent migrants in seven English and Welsh towns and supplemented by an analysis of qualitative data. Three categories of migrants are initially identified on the basis of their intentions of stay in the UK. Multinomial logit models are then estimated to examine the characteristics of individuals in each category to establish the factors that influence migration strategies and changes in plans. Results indicate that although standard socio-economic characteristics tend to be insignificant, migration strategies and changes in intentions are affected by migrant's view of whether their job matches their expectations, the time of entry into the UK and remittances. Analysis of the qualitative information reinforces some of the key findings and also indicates the importance of migrants' ability to reference their experiences in two settings. [ABSTRACT FROM AUTHOR]

Context Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. Objectives This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Methods Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Results Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Conclusions Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure. [ABSTRACT FROM AUTHOR]

This paper examines the parallel discourses of 'lost' local flood expertise and the growing use of commercial consultancies to outsource aspects of flood risk work. We critically examine the various claims and counter-claims about lost, local and external expertise in flood management, focusing on the aftermath of the 2007 floods in East Yorkshire, England. Drawing on interviews with consultants, drainage engineers and others, we caution against claims that privilege 'local' floods knowledge as 'good' and expert knowledge as somehow suspect. This paper urges carefulness in interpreting claims about local knowledge, arguing that it is important always to think instead of hybrid knowledge formations. We conclude by arguing that experiments in the co-production of flood risk knowledge need to be seen as part of a spectrum of ways for producing shared knowledge. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to investigate the characteristics of the highest cost residential placements provided for adults with learning disabilities in the South East of England, comparing findings with a previous survey. Design/methodology/approach -- Lead commissioners for NHS and Local Authority teams in the South-East of England were asked to provide information on the five highest cost placements that they currently commissioned. Findings -- The average placement cost was £200,000 per annum with a range from £81,000 to £430,000 per annum. Individual characteristics of people placed were broadly similar to those identified in previous studies. Originality/value -- Significant resources are used to support relatively few individuals. These individuals' needs and characteristics suggest areas for research and practice development. [ABSTRACT FROM AUTHOR]

Purpose -- Joint Strategic Needs Assessments (JSNAs) are required for every local authority in England, and should contain information to allow for strategic health and wellbeing planning for the local population, including disabled people. A 2013 analysis of JSNAs showed that JSNAs were not routinely including information on the numbers and health needs of people with learning disabilities, particularly children. The purpose of this paper is to compare the information included in 2013 and 2014 JSNAs. Design/methodology/approach -- JSNAs for 141 local authorities in England were sought. Local authorities were contacted when JSNAs were not initially found online. All 137 JSNAs found were analysed for mentions and specific sections concerning people with learning disabilities, and content analysed concerning the specific information they contained. Findings -- In total, 72 per cent of JSNAs mentioned people with learning disabilities (vs 82 per cent in 2013); 24 per cent mentioned children (vs 39 per cent in 2013) and 72 per cent mentioned adults (vs 81 per cent in 2013). Overall, 13 per cent of JSNAs included a section on children with learning disabilities (vs 9 per cent in 2013), 65 per cent included a section on adults (vs 48 per cent in 2013) and 11 per cent included a section on older adults (vs 8 per cent in the 2013). More JSNAs contained information on current and projected future populations, health needs, social context and service usage concerning adults with learning disabilities compared to children. There was large regional variation in all these indicators. Originality/value -- Further work is needed for JSNAs to contain sufficient information on people with learning disabilities to allow for strategic planning, and for JSNAs to be accessible to the public. [ABSTRACT FROM AUTHOR]

There has been a growing debate concerning the increasing salience of sport to government in the UK and the role and value of community-level sport policy. Much of this debate has centred on the role of voluntary sport clubs (VSCs) and the extent to which they can contribute to the creation of social capital. This paper contributes to this debate through a case study of sport policy implementation in England. The case study firstly highlights the strategic importance attached to social capital and its associated policy context and secondly presents key stakeholder interpretations of the likelihood that VSCs will act as agents of delivery. The analysis is served by three considerations. Firstly, what is the political and policy context for a strategic orientation to social capital? Secondly, how does this orientation relate to stakeholder perceptions of what VSCs do? Thirdly, how do stakeholder perceptions of what VSCs do affect their perceptions of how they do it? The analysis is informed by a series of 14 semi-structured interviews with a number of key stakeholders and a range of public documents produced by government, local authorities and regional agencies. The conclusions suggest that, firstly, the democratic form of social capital is most dominant in relation to sport policy and, secondly, that when considered alongside VSC stakeholder perceptions, then anticipated democratic social capital outcomes may become distorted and even corrupted. [ABSTRACT FROM PUBLISHER]

Purpose -- The purpose of this paper is to explore change within the commissioning of third sector mental health services in England. Design/methodology/approach -- A case study methodology based on survey and interview data of a sample of third sector organisations and commissioners within an English conurbation. Findings -- Normative commissioning models based on sequential cycles were not fully implemented with the main focus being on the procurement and contracting elements. There were examples of commissioning being an enabler of service improvement but overall it seems to have been limited in its ability to bring about whole system change. Barriers included commissioners' capacity and competence, ineffectual systems within their organisations, and fragmentation in commissioning processes between user groups, organisations and sectors. Research limitations/implications -- The case study conurbation may not represent practice in all urban areas of England and there may be particular issues of difference within rural localities. The view of private and public sector providers and those working in Commissioning Support Units were not sought. Practical implications -- To lead whole system change the commissioning function needs to be adequately resourced and skilled with better integration across public sector functions and organisations. Greater emphasis needs to be placed on implementing the full commissioning cycle, including the engagement of relevant stakeholders throughout the process and the practical application of outcomes. Originality/value -- This research adds to the limited body of empirical work regarding commissioning in mental health. [ABSTRACT FROM AUTHOR]

Successive attempts to reform planning practice in England have given rise to an impression that planning is “under attack”. Various academic commentaries have performed the valuable service of cataloguing aspects of this reform agenda, often within the context of the analytical framework offered by neoliberalization. In this paper, we seek to chronicle the cumulative effects of the sustained programme of neoliberalization to which urban and environmental planning has been subjected in England over a period spanning approximately the last 15 years. In doing so, we hope to show why planning has been such an intractable issue for all governments that have sought its reform irrespective of the particularities of their political agenda. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the shortage of medical product, and its impact on service delivery and patient outcome at the National Health Service (NHS) Trust facilities in England. The researchers used a consensus development approach and identified at-risk products which have the greatest impact on patient care. These products are ranked depending on their threats to the medical supply chain and on the opportunities for change.

Purpose – The purpose of the paper is to report the findings from research into the governance of adult protection in Scotland, with particular focus on the outcomes of provision for multi-agency leadership and management of adult safeguarding in the Adult Support and Protection (Scotland) Act 2007. Comparisons will be drawn between these findings and the evidence on the governance of adult safeguarding in England. Design/methodology/approach – The study comprised a thematic analysis of Adult Protection Committee (APC) biennial reports on implementation of the 2007 Act to the Scottish Government, associated documentation, and key informant interviews with professionals involved in adult protection leadership and practice. Findings – A rich and complex pattern of arrangements, activities, experiences and challenges were identified across a number of dimensions, including management structures of APCs, development of policies and procedures, multi-agency working, training, performance assessment and quality management, engagement of service users and carers and operation of the 2007 Act. Research limitations/implications – Service users and carers were not directly involved in the documentary review or key informant interviews. There remains a need to investigate the impacts on practice and service user experience of different forms of governance of adult protection arrangements. Practical implications – The paper identifies outcomes and challenges in respect of multi-agency approaches to governance taken by APCs in Scotland. Originality/value – The paper offers the first formal evaluation of governance of adult protection systems in Scotland and includes comparative analysis with research findings on the governance of adult safeguarding in England. [ABSTRACT FROM AUTHOR]

This paper presents a critical analysis of the development of government policy and practice on health research, development and innovation over the last 25 years -- starting from the publication of a seminal report from the House of Lords Science and Technology Committee in 1988. We first set out to map and analyse the trends in ideas and thinking that have shaped research policy and practice over this period, and to put the development of health research, development and innovation in the wider context of health system reforms and changes. We argue that though this has been a transformative period for health research, rather less progress has been made in the domains of development and innovation, and we offer an analysis of why this might be the case. Drawing on advances in our understanding about how research informs practice, we then make the case for a more integrative model of research, development and innovation. This leads us to conclude that recent experiments with Collaborations for Leadership in Applied Health Research and Care and Academic Health Science Centres and Networks offer some important lessons for future policy directions. [ABSTRACT FROM AUTHOR]

Abstract: England and Wales has a long history of recognising coastal change, where coastal morphology adjusts in response to changing patterns of erosion and accretion, especially in the vicinity of ports and reclamations in estuaries. The long history of responses to coastal change can be linked to the history of coastal engineering, the wider development of coastal management; and most recently shoreline management, as a policy framework for managing flood and erosion risks on changing coasts. Coastal change is ongoing and long-term so that management is necessarily a process and effective delivery requires an adequate monitoring programme to inform management decisions. Monitoring also enables adaptive and flexible solutions to be implemented that take account of the inherent uncertainties such as future climate, promoting well adapted rather than mal-adapted outcomes. Given the current concerns about accelerated rates of sea-level rise and climate change this paper considers the development of both shoreline management and the supporting national monitoring programme in England to assess whether the SMP process remains useful in these circumstances. The lessons and experience are widely transferable. [Copyright &y& Elsevier]

Abstract: Aims: The Malthus Programme has delivered a tool for modelling radiotherapy demand in England. The model is capable of simulating demand at the local level. This article investigates the local and regional level variation in predicted demand with respect to Breast and Prostate cancer, the two tumour types responsible for the majority of radiotherapy treatment workload in England. Materials and methods: Simulations were performed using the Malthus model, using base population incidence data for the period from 2007–2009. Simulations were carried out at the level of Primary Care Trusts, Cancer Networks, and nationwide, with annual projections for 2012, 2016 and 2020. Benchmarking was undertaken against previously published models from the UK, Canada and Australia. Results: For breast cancer, the fraction burden for 2012 varied from 5537 fractions per million in Tower Hamlets PCT to 18 896 fractions per million in Devon PCT (national mean - 13 592 fractions per million). For prostate cancer, the fraction burden for 2012 varied from 4874 fractions per million in Tower Hamlets PCT to 23 181 fractions per million in Lincolnshire PCT (national mean - 15 087 fractions per million). Predictions of population growth by age cohort for 2016 and 2020 result in the regional differences in radiotherapy demand becoming greater over time. Similar effects were also observed at the level of the cancer network. Conclusions: Our model shows the importance of local population demographics and cancer incidence rates when commissioning radiotherapy services. [Copyright &y& Elsevier]

National GP demographic data demonstrate an increasing 'feminisation' of the workforce. With female GP specialty trainees continuing to outnumber males, this trend is set to continue. The changing composition of the workforce presents challenges in terms of how best to support the long-term career and educational development needs of this sector of the workforce in an evolving healthcare context. The aim of this work was to capture female GPs' experiences of working in general practice and their expectations concerning their career and educational development. Participants were surveyed and completed a semi-structured questionnaire, which generated qualitative and quantitative data. The sample comprised GP registrars, principals and sessionals. This study has generated an important dataset on working patterns, educational experiences and long-term career intentions of female GPs. Despite increased representation in the GP workforce, female GPs (particularly those with young children) appear less likely to be involved in education and training than their male counterparts, and even less likely to be involved in roles linked to primary care trusts, medico-political issues, hospital service delivery, special clinical interests or deanery education management. Younger GPs reported significantly more difficulties in managing their childcare needs than older colleagues. Marital status, number of children and employment status did not moderate the effect of these difficulties. Female GPs reported working more hours with increasing age, but were not necessarily represented in a range of educational and/or training posts as a consequence. [ABSTRACT FROM AUTHOR]

A number of fundamental concerns have been raised over the recent abolition of regional economic and planning institutions processes and associated plans and strategies in England. In particular, questions have arisen over the strength and democratic accountability of the new arrangements emerging at a sub-regional scale--namely local enterprise partnerships (LEPs) that as yet have neither legal powers nor any formal planning role. Consequently, this article critically assesses the role, provenance and value of the abolished regional institutions together with the parallel criticisms. It also examines the potential for LEPs as their replacement and to develop into democratically accountable, locally self-determined strategic planning bodies. [ABSTRACT FROM AUTHOR]

There has been growing concern that English local authorities are over reliant on temporary staff to meet the shortage of social workers. This has been criticised as inefficient and costly while leading to problems of continuity and consistency for people using social work services. Focussing on recent policy and the implementation of new administrative procedures for the procurement and management of temporary or agency staff, this article explores progress being made towards achieving the previous government's policy goal that by 2020 local authorities will no longer need to rely on agency workers to carry out tasks that would normally be carried out by a permanent social worker. The article draws on the findings of an exploratory study (2007-2010) commissioned by the Department of Health which comprised of the following: a survey of local councils in England with adult social services responsibilities; case studies in three different localities; and qualitative interviews with stakeholders ( n = 93). The findings suggest that while local authorities have reduced the costs of employing temporary staff through the setting up of intermediary control mechanisms, agency social workers continue to play important roles in teams and services. [ABSTRACT FROM AUTHOR]

The author examines the determinants of the location choices of recent immigrants in England, using aggregate Department for Work and Pensions National Insurance Number registration data matched to ward and local authority district contextual data. Separate models are estimated for four recent immigrant groups, according to world area of origin, using a tobit regression modelling strategy. The results suggest that higher neighbourhood co-ethnic density and ethnic diversity levels, and higher deprivation levels, are associated with increased immigrant settlement. Most immigrants are more likely to settle in neighbourhoods with a higher availability of rented housing and lower access to employment. Compared with the other groups, EU Accession nationals and Africans are more likely to settle in deprived areas and African settlement is also more pronounced in areas with a higher availability of social housing. EU Accession nationals, unlike immigrants from more established immigrant groups, are found to be less likely to settle in large urban districts and more likely to settle in districts with lower unemployment levels. [ABSTRACT FROM AUTHOR]