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Males accounted for half the United Kingdom population in 2021 yet they fail to be prioritised in health and social policies. As examining the health of males and females collectively falls short in accounting for the complexities associated with gendered health outcomes, male health should be considered as a separate policy issue. The island of Ireland has two jurisdictions, the Republic of Ireland and Northern Ireland (NI); however, only the former has implemented a men's health policy. As well as a policy vacuum within NI, few studies have comprehensively examined male health. To address this shortcoming, a narrative review of males' physical and mental health trends in NI is presented to determine the need for a men's health policy. A collation of secondary administrative data and survey data was conducted. The narrative review highlights the importance of utilising a holistic framework to understand men's health. Key findings include high male suicide rates and young males being more likely to report certain mental health problems. The study concludes that a male health policy is needed. To achieve this, a Health Impact Pyramid was developed, and it illustrates practical steps that can be taken to support decision-makers, service providers and individual males., (© 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

COVID-19 in the UK has had a profound impact on population health and other socially important outcomes, including on education and the economy. Although a range of evidence has guided policy, epidemiological models have been central. It is less clear whether models to support decision making have sought to integrate COVID-19 epidemiology with a consideration of broader health, wellbeing and economic implications. We report on a rapid review of studies seeking to integrate epidemiological and economic modelling to assess the impacts of alternative policies. Overall, our results suggest that few studies have explored broader impacts of different COVID-19 policies in the UK. Three studies looked only at health, capturing impacts on individuals with and without COVID-19, with various methods used to model the latter. Four models considered health and wider impacts on individuals' economic outcomes, such as wages. However, these models made no attempt to consider the dynamic impacts on economic outcomes of others and the wider economy. The most complex analyses sought to link epidemiological and dynamic economic models. Studies compared a wide range of policies, although most were defined in general terms with minimal consideration of their granular specifications. There was minimal exploration of uncertainty, with no consideration in half the studies. Selecting appropriate models to inform decisions requires careful thought of factors relevant to the decision options under consideration such as the outcomes of interest, sectors likely to be impacted and causal pathways. In summary, better linking epidemiological and economic modelling would help to inform COVID-19 policy., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Worldwide, population obesity levels are at their highest recorded levels, having nearly tripled between 1975 and 2016. This leads to substantial pressure on health systems, a negative impact on economic development, and results in adverse physical and mental health outcomes. There are many economic reasons why reducing population obesity should be a priority, and global targets have been set with many governments pledging to reduce obesity levels by 2030. To achieve these targets, a 'system-wide' approach has been widely advocated in direct recognition of the wide-ranging complex interacting determinants of the disease. This system approach requires action at all levels, including at the local government level, to use all fiscal and non-fiscal levers to bring about local system change that promotes healthier population behaviours. Like many country contexts, in England, local resources for achieving this system change have been drastically reduced in recent years. Economic evaluation offers a formal explicit framework to support local decision making but, to date, there has been a disconnect between national guidance on cost-effectiveness and how that informs local action. A new Centre for Economics of Obesity has been purposively developed to work closely with local government to adapt methods to help achieve efficiency and equity gains. By working across six workstreams to begin with, this Centre will use economics to inform policy action on different but interrelated parts of the obesity system and act as a training hub for health economists working in obesity policy., (© 2022. The Author(s).)

Purpose: This study aims to critically examine the effects of COVID-19 social discourses and policy decisions specifically on older adult volunteers in the UK, comparing the responses and their effects in England, Scotland, Wales and Northern Ireland, providing perspectives on effects of policy changes designed to reduce risk of infection as a result of COVID-19, specifically on volunteer involvement of and for older adults, and understand, from the perspectives of volunteer managers, how COVID-19 restrictions had impacted older people's volunteering and situating this within statutory public health policies. Design/methodology/approach: The study uses a critical discourse approach to explore, compare and contrast accounts of volunteering of and for older people in policy, and then compare the discourses within policy documents with the discourses in personal accounts of volunteering in health and social care settings in the four nations of the UK. This paper is co-produced in collaboration with co-authors who have direct experience with volunteer involvement responses and their impact on older people. Findings: The prevailing overall policy approach during the pandemic was that risk of morbidity and mortality to older people was too high to permit them to participate in volunteering activities. Disenfranchising of older people, as exemplified in volunteer involvement, was remarkably uniform across the four nations of the UK. However, the authors find that despite, rather than because of policy changes, older volunteers, as part of, or with the help of, volunteer involving organisations, are taking time to think and to reconsider their involvement and are renewing their volunteer involvement with associated health benefits. Research limitations/implications: Working with participants as co-authors helps to ensure the credibility of results in that there was agreement in the themes identified and the conclusions. A limitation of this study lies in the sampling method, as a convenience sample was used and there is only representation from one organisation in each of the four nations. Originality/value: The paper combines existing knowledge about volunteer involvement of and for older adults. [ABSTRACT FROM AUTHOR]

Introduction: There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. Methods: A public consultation was undertaken with people of any gender aged 18–50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. Results: Fifty‐four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18–30 years, 30% 31–40 years, 15% 41–50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender‐sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well‐being during the childbearing years', 'health and well‐being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School‐based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. Conclusion: This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co‐development of public awareness campaigns and guidance for healthcare professionals. Patient or Public Contribution: This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co‐authors of the paper. [ABSTRACT FROM AUTHOR]

Physical activity and healthy eating are important for physical and mental health, yet long-standing inequalities constrain the ability of ethnic minorities in the United Kingdom (UK) to adopt these behaviours. Programmes aimed to improve these behaviours have also often not been engaged with by these communities. This study therefore aimed to: (1) identify the values underlying the physical activity and healthy eating behaviours of UK ethnic minorities and (2) explore how structural, socio-economic and environmental factors interact with these values to influence their physical activity and healthy eating behaviours. The study adopted a relativist ontological and subjectivist epistemological philosophical assumption. Qualitative interviews were used to address research objectives. A total of 10 group and five individual interviews were conducted with 41 participants. All participants were from an ethnic minority background (Black, Asian or Mixed according to the UK Office for National Statistics classification), recruited purposively and aged between 18 and 86 years and were living in England and Wales. Data were analysed using inductive thematic analysis. Community engagement was embedded throughout the study. We found that culture and family, community and social life, and health are important values underlying the physical activity and healthy eating behaviours of UK ethnic minority communities. External factors, including racism and access (geographical, social and economic), interact with these values to drive health behaviours. Using an illustrative guide, we conclude the paper with policy and practice recommendations on how public health programmes on physical activity and healthy eating can be aligned with these values to ensure relevance for ethnic minority communities. [ABSTRACT FROM AUTHOR]

In response to the heightened risk that coronavirus disease 2019 (COVID-19) poses to the health and lives of people with obesity, in 2020 the U.K. government launched a new package of policies intended to stimulate weight loss among the country's population. In this article, I present a critical discourse analysis of the policy paper which announced these new measures. I identify the discourses that are used to represent things, people, and processes in this policy text. These discourses are interpreted in terms of broadly neoliberal ideologies of public health management. Taken together, the discourses identified contribute to a broadly neoliberal ideology of public health management. It is argued that the policy paper represents an instance of "lifestyle drift," as it initially appears to engage with social and economic determinants of health but ultimately neglects these in favor of focusing on individual lifestyle factors, particularly in the shape of individuals' "choices." [ABSTRACT FROM AUTHOR]

This paper critically comments on the state of affairs in the UK relating to the pandemic and explores how a focus on inequities experienced by marginalized and vulnerable groups is necessary for exposing the material realties of everyday life, but also how such a focus has been hijacked by center right politics to distract us from collective responsibilities and building alliances for systemic change. The paper critically reviews the impact of the COVID‐19 pandemic on the most marginalized and vulnerable in UK society and highlights the interconnected risk factors of COVID‐19 and its secondary impacts to demonstrate how these are linked to political ideology, policy, and practice. We conclude with recommendations informed through a looking back at the key tenants and purposes of universal healthcare to apprise what is needed in this moment of crisis and beyond. [ABSTRACT FROM AUTHOR]

Introduction: This paper is a report of an ICSH review of policies and practices for internal quality control (IQC) policy for haematology cell counters among regulatory bodies, cell counter manufacturers and diagnostic laboratories. It includes a discussion of the study findings and links to separate ICSH guidance for such policies and practices. The application of internal quality control (IQC) methods is an essential pre‐requisite for all clinical laboratory testing including the blood count (Full Blood Count, FBC, or Complete Blood Count, CBC). Methods: The ICSH has gathered information regarding the current state of practice through review of published guidance from regulatory bodies, a questionnaire to six major cell counter manufacturers (Abbott Diagnostics, Beckman Coulter, Horiba Medical Diagnostic Instruments & Systems, Mindray Medical International, Siemens Healthcare Diagnostics and Sysmex Corporation) and a survey issued to 191 diagnostic laboratories in four countries (China, Republic of Ireland, Spain and the United Kingdom) on their IQC practice and approach to use of commercial IQC materials. Results: This has revealed diversity both in guidance and in practice around the world. There is diversity in guidance from regulatory organizations in regard to IQC methods each recommends, clinical levels to use and frequency to run commercial controls, and finally recommended sources of commercial controls. The diversity in practice among clinical laboratories spans the areas of IQC methods used, derivation of target values and action limits used with control materials, and frequency of running commercial controls materials. Conclusions: These findings and their implications for IQC Practice are discussed in this paper. They are used to inform a separate guidance document, which proposes a harmonized approach to address the issues faced by diagnostic laboratories. [ABSTRACT FROM AUTHOR]

An editorial is presented on the possible implications of personalization for adult care social workers. It outlines the considerable relevance for social work for the foreseeable future. An overview of the how similar personalization policy agendas in England and the Italian region of Lombardy are translated into practice is presented.

Qualitative research has long critiqued a simplistic association between youth parenting and poor outcomes. Despite this, the UK youth parenting policy continues to view young parents through a narrow deficit lens, focused on assumed risk rather than structural inequalities. The paper brings together the direct accounts of young parents' experiences, with ethnographic observation of practice, to argue that discrimination is the critical issue associated with being a young parent. This is then set within a wider critique of the policy framework which, it is argued, perpetuates and normalises negative ideas about young parents prevalent in political, societal and cultural processes. An integrative theoretical approach is used to highlight how a deficit lens at a policy level upholds, rather than undermines, young parents' intersectional experiences of discrimination and has ethical implications for practitioners working with them. The paper calls for a reorientation of policy which addresses and disrupts discrimination. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities face health disparities, including in high‐income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID‐19 pandemic, and the implementation of the Valuing People white paper are discussed. [ABSTRACT FROM AUTHOR]

UK social care policy has "traditionally" sought to minimise organisational and sector boundaries through cooperation and partnership. This discussion paper argues that there is a case for a social care system based openly on separation of powers to address the conflicts of interest that inevitably exist between the actors—notably local authorities and service providers. Such systems, with "guardrails" to separate the actors, and "checks and balances" to keep them stable, have been developed over centuries in other spheres. Furthermore, if disabled people are to be considered as participants with rights, rather than mere recipients, they should be recognised as the third main actor in the system, also with powers that are protected and constrained. This paper takes a 50‐year retrospective view of these issues in terms of policy affecting people with learning disabilities, focusing on three policy episodes in the UK. First, the 1970s, with a system unbalanced by powerful medical professions, and an absence of self‐advocacy. Second, care management in the 1990s, which ducked the spirit of Sir Roy Griffiths' vision of a lively provider market. Third, the adoption and degradation of Personal Budgets. The learning from UK and international individualised funding programmes is too complex to be certain which ingredients are the keys to success. However, there are strong arguments, and substantial evidence, to suggest that Personal Budgets will not truly succeed until they are built on a structure that determines not only what councils and providers can and should do but also where they must not interfere. Accessible summary: •It is a nice idea that everyone involved in social care—the council, the service providers and people with learning disabilities—all want the same thing. If that is true, then they all need to work together as closely as they can.•But it is not really true. Council staff who do assessments and people who run services see things from different viewpoints. A person who wants support services will see things another way. That does not mean that anyone is a bad person, and a lot of the time they will want the same thing. But we are all human, and sometimes we pretend we are doing what we should do, when actually it is what suits us.•If you need a Personal Budget, the council may try to say you do not need much support, because that will save money. The support provider may want to tell you when you will get support, because it makes life easier for them, not you.•So maybe we should be more honest, and organise the system so that people have the power to do their job, but do not have the power to interfere when they should not. Disabled people should be part of this system, so that they have some power as well. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to highlight the issue of carers as victims and perpetrators of domestic abuse. The issue of carers as victims, and sometimes perpetrators, of domestic abuse is being overlooked by statutory organisations because they often do not fit the traditional patterns of abusive relationships, and the complexities of the caring role can make typical safety options unsuitable. However, caring responsibilities are a feature of an increasing number of domestic homicide reviews, and current statutory safeguarding options exclude most carers from support and risk not identifying perpetrators. Design/methodology/approach: This short paper highlights some of the shortfalls around identifying the needs of carer victims/survivors of domestic abuse and carer-perpetrators of domestic abuse and explores ways in which identification and support could be improved. Findings: Carers as victims/survivors of domestic abuse, and as abusers, is an issue that requires more attention from researchers and Adult Social Care, NHS, Carer Support Organisations and Domestic Abuse specialists need to work together to explore these issues and offer workable options. Originality/value: Little data or research exists around carers as victims or perpetrators of domestic abuse. [ABSTRACT FROM AUTHOR]

Purpose: Supporting the mental health of children and young people is a global priority. The issue is not specific to England. However, evidence suggests that one in ten children and young people in England has a mental health need. This represents approximately three students in every classroom. The purpose of this paper is to highlight the role of schools in supporting children and young people's mental health. Whilst the paper acknowledges that teachers are not trained health professionals, it is argued that a whole-school approach to mental health can support individuals in schools to remain mentally healthy. The elements of a whole-school approach are identified and discussed and some of the challenges in relation to implementation are considered. Critical to the development of a whole-school approach is the commitment from the school leadership team to promoting student and staff wellbeing. Design/methodology/approach: This is a policy paper not an empirical study. Findings: This paper has outlined the policy context in the UK in relation to children and young people's mental health. It has addressed the risk and protective factors which can cause or mitigate against mental ill health and it has outlined the elements of a whole-school approach to mental health. Originality/value: This paper explores the contribution that schools can make to supporting students' mental health. There is limited research which addresses mental health in young people from a non-therapeutic angle. [ABSTRACT FROM AUTHOR]

Background: Twenty miles per hour (20mph) speed limits (equivalent to roughly 30kmh) have become part of public health policies to reduce urban road collisions and casualties, especially in Western countries. Public opinion plays a crucial role in opposition to and acceptance of policies that are advocated for improving public health. Twenty miles per hour speed limit policies were implemented in Edinburgh and Belfast from 2016 to 2018. In this paper, we extract public opinion and sentiments expressed about the new 20mph speed limits in those cities using publicly available Twitter data. Methods: We analysed public sentiments from Twitter data and classified the public comments in plain English into the categories 'positive', 'neutral', and 'negative'. We also explored the frequency and sources of the tweets. Results: The total volume of tweets was higher for Edinburgh than for Belfast, but the volume of tweets followed a similar pattern, peaking around 2016, which is when the schemes were implemented. Overall, the tone of the tweets was positive or neutral towards the implementation of the speed limit policies. This finding was surprising as there is a perception among policymakers that there would have been public backlash against these sorts of policy changes. The commonly used hashtags focused largely on road safety and other potential benefits, for example to air pollution. Conclusions: Overall, public attitudes towards the policies were positive, thus policymakers should be less anxious about potential public backlash when considering the scale-up of 20mph speed restrictions. [ABSTRACT FROM AUTHOR]

Introduction: Since non‐directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. Methodology: This paper uses publicly‐available data to assess the expected value that accrues to the donor of altruistic kidney donation. Findings: Compared to healthy non‐donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non‐donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed. Conclusion: Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non‐directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic. [ABSTRACT FROM AUTHOR]

In 2019 the For The Assessment Of Individualised Risk (FAIR) project began a review of UK blood donor selection policy to determine if a more individualised approach to donor selection could be safely implemented. An evidence base was required to inform selection policy to move from a population to a more individual based policy, specifically what sexual behaviours/indicators should be considered as screening questions to maintain the safety of the blood supply. Eight sexual behaviours/indicators were reviewed: history of bacterial sexually transmitted infections (STIs), chemsex, number of recent partners, condom use, type of sex, sexual health service (SHS) attendance, new sexual partner and exclusivity. We conducted searches in multiple databases to identify literature looking at the association between these behaviours/indicators and HIV/STI acquisition risk. A scoring system to determine strength of evidence was devised and applied to papers that passed screening. Key studies were identified which achieved the maximum score and more in‐depth reviews were conducted for these. We identified 58 studies, including 17 key studies. Strong evidence was found linking a previous bacterial STI, chemsex and increasing numbers of sexual partners to acquisition risk. Condom use, type of sex and new partners were found to have some strength of evidence for this link. SHS attendance and exclusivity had minimal evidence. We recommended that the behaviours/indicators viewed as having strong or some strength of evidence should be considered as screening questions in a more individualised approach to donor selection criteria. [ABSTRACT FROM AUTHOR]

Complementing the well-established evidence base on health inequalities experienced by migrants, refugees and asylum seekers in the UK; we examined the extent to which their right to equal non-discriminatory access to health services (promotive, preventive, curative) was upheld during the COVID-19 pandemic. Arksey and O′Malley's scoping review framework. A comprehensive search was conducted on Medline, PubMed, and CINAHL using detailed MESH terms, for literature published between 01 January 2020 and 01 January 2024. The process was supported by a ten-page Google search and hand searching of reference lists. 42 records meeting the inclusion criteria were charted, coded inductively and analysed thematically in an integrated team-based approach. Dissonance between immigration regulation and health governance is illustrated in four themes: Health systems leveraged to (re)enforce the hostile environment; Dissonance between health rights on paper and in practice; Structural failures to overcome communication and digital exclusion; and COVID-19 vaccine (in)equity exacerbated fear, mistrust and exclusion. Migrants, refugees and asylum seekers encountered substantial individual, structural and policy-level barriers to accessing healthcare in the UK during COVID-19. Insecure immigration status, institutional mistrust, data-sharing and charging fears, communication challenges and digital exclusion impacted heavily on their ability to access healthcare in an equitable non-discriminatory manner. An inclusive and innovative health equity and rights-based responses reaching all migrants, refugees and asylum seekers are warranted if the National Health Service is to live up to its promise of ' leaving no one behind' in post-pandemic and future responses. [ABSTRACT FROM AUTHOR]

The last decade has seen significant developments in UK health policy, with are largely claimed to be evidence based. However, such a characterisation ought, in many cases, to be questioned. Policies can be broadly understood as based primarily on either a logical or empirical case. In the absence of relevant empirical evidence, policymakers understandably appeal to logical cases. Once such evidence is available, however, it can inform policy and enable the logical case to be set aside. Such a linear policy process is not always the reality, and logical cases often continue to guide policy decisions in direct opposition to empirical evidence. In this paper, I discuss two recent examples of this disconnect between logical and empirical cases in UK health policy. The first-organ donation-illustrates an example of a significant policy change being made in opposition to the evidence. I refer to this as the improvidence approach. The second-abortion-provides an example of policymakers not making a change that has extensive supporting data. I refer to this using the more recognisable language of the precautionary approach. Ultimately, I argue that both the improvidence and precautionary approaches are examples of problematic public policy where policymakers provide no explicit justification for going against the evidence., (© 2022. The Author(s).)

Background: Responsibility for health and social care was devolved to Scotland in 1999 with evidence of diverging policy and organisation of care compared to England. This paper provides a comparative overview of major health and social care policies in England and Scotland published between 2011 and 2023 relating to the care of older people., Methods: We searched United Kingdom (UK) and Scotland government websites for macro-level policy documents between 2011 and 2023 relating to the health and social care of older people (aged 65+). Data were extracted and emergent themes were summarised according to Donabedian's structure-process-outcome model., Results: We reviewed 27 policies in England and 28 in Scotland. Four main policy themes emerged that were common to both countries. Two related to the structure of care: integration of care and adult social care reform. Two related to service delivery/processes of care: prevention and supported self-management and improving mental health care. Cross-cutting themes included person-centred care, addressing health inequalities, promoting use of technology, and improving outcomes., Conclusion: Despite differences in the structure of care, including more competition, financial incentivization, and consumer-based care in England compared to Scotland, there are similarities in policy vision around delivery/processes of care (e.g. person-centred care) and performance and patient outcomes. Lack of UK-wide health and social care datasets hinders evaluation of policies and comparison of outcomes between both countries., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: Although medication abortion has become more common in high-income countries, the procedure has not yet met early expectations for widening access to abortion. High-quality evidence can serve as a catalyst for changes in policy and practice. To direct research priorities, it is important to understand where quality evidence is concentrated and where gaps remain. High-income countries have developed a body of evidence that may have implications for the future of medication abortion. This literature review assesses the characteristics and quality of published studies on medication abortion conducted in the last 10 years in high-income countries and indicates future areas for research to advance policy and practice, and broaden access. Study design: A structured search for literature resulted in 207 included studies. A framework based upon the World Health Organization definition of sub-tasks for medication abortion was developed to categorize research by recognized stages of the medication abortion process. Using an iterative and inductive approach, additional sub-themes were created under each of these categories. Established quality assessment frameworks were drawn upon to gauge the internal and external validity of the included research. Results: Studies in the US and the UK have dominated research on MA in high-income countries. The political and social contexts of these countries will have shaped of this body of research. The past decade of research has focused largely on clinical aspects of medication abortion. Conclusion: Researchers should consider refocusing energies toward testing service delivery approaches demonstrating promise and prioritizing research that has broader generalizability and relevance outside of narrow clinical contexts. Plain English summary: Although medication abortion is more commonly available worldwide, it is not being used as often as people thought it would be, particularly in high income countries. In order to encourage changes in policy and practice that would allow greater use, we need good quality evidence. If we can understand where we do not have enough research and where we have good amounts of research, we can determine where to invest energies in further studies. Many high-income countries have produced research on medication abortion that could influence policy and practice in similarly resourced contexts. I conducted a literature review to be able to understand the type and quality of research on medication abortion conducted in high-income countries in the past 10 years. I conducted the review in an organized way to make sure that the papers reviewed discussed studies that I thought would be important for answering this question. The literature review found 207 papers. Each of these papers were reviewed and organized them by theme. I also used existing methods to determinine the quality of each study. Most of the research came from the US and the UK. Furthermore, most of the research conducted in the past 10 years was focused on clinical studies of medication abortion. In future studies, researchers should focus more on new ways of providing medication abortion to women that offers greater access. Also, the studies should be designed so that the results have meaning for a broader group of people or situations beyond where the study was done. [ABSTRACT FROM AUTHOR]

Purpose: There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach: This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings: This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value: In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed. [ABSTRACT FROM AUTHOR]

Background: Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs.Methods: A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected.Results: The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement).Conclusions: The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated. [ABSTRACT FROM AUTHOR]

Purpose: The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries. Design/methodology/approach: The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy. Findings: Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations. Originality/value: This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to reflect upon the experiences of a senior nurse in a patient‐facing role, who led a tea providing direct care to those with coronavirus disease 2019 (covid‐19). This would establish what those experiences meant to nurses during the initial outbreak to enable their coping mechanisms to face subsequent waves in the United Kingdom. Background: The worst infectious disease outbreak of a generation rapidly made its impact known to the medical profession and its support infrastructure across the globe. It imparted unprecedented challenges, not only for managing the care of the most critically ill but for minimising its spread and protecting the workforce. Sources of evidence: Reflections of working on the covid‐19 frontline during the initial stages of the pandemic, the challenges faced, and lessons learned enabled the development of a strategy to better support nurses in the ongoing pandemic. Discussion: Visible, invested and consistent leadership was key in forming a strong foundation to support clear communication, peer support and increasing confidence. Consequently, strong bonds were forged to enable the team to face further challenges as they felt 'in it together'. Summary and implications for nursing and health policy: The experiences described in this paper are those of a senior nurse leader within a particular care context. However, the lessons learned are likely to resonate with many nurses who are facing the same challenges in very similar care contexts and who are urged to reflect upon their own experiences. Furthermore, the associated lessons may help support others and inform their strategy for coping throughout potential future admission surges of this pandemic. [ABSTRACT FROM AUTHOR]

Public health policy analysis lacks theoretical foundations and tends not to be evidence-based. This is apparent in the areas of dietary health needs assessment, the problematization of issues, and subsequently, conceptual policy generation. However, this paper will demonstrate that theory utilised in process engineering can lend itself to dietary health policy analysis; it will show that a scheme which addressed a UK food issue during the COVID-19 pandemic was based upon apparent public needs, rather than being based on public actual needs, and so rather than safeguarding health, the scheme may have resulted in the unintended, reverse consequence of being injurious to health. Using such theory, this paper then presents a proposal which could help to meet global governance drivers which address food and nutrition insecurity. [ABSTRACT FROM AUTHOR]

This paper is a description of the ICSH guidance for internal quality control (IQC) policy for blood cell counters. It follows from and links to a separate ICSH review for such policies and practices. The ICSH has gathered information regarding the current state of practice through review of published guidance from regulatory bodies, a questionnaire to six major cell counter manufacturers and a survey issued to 191 diagnostic laboratories in four countries (China, the Republic of Ireland, Spain, and the United Kingdom) on their IQC practice and approach to the use of commercial IQC materials. This has revealed diversity both in guidance and in practice around the world. There is diversity in guidance from regulatory organizations in regard to IQC methods each recommends, clinical levels to use and frequency to run commercial controls, and finally recommended sources of commercial control materials. The diversity in practice among clinical laboratories spans the areas of IQC methods used, derivation of target values, and action limits used with commercial control materials, and frequency of running commercial controls materials. These findings and their implications for IQC Practice are addressed in this guidance document, which proposes a harmonized approach to address the issues faced by diagnostic laboratories. [ABSTRACT FROM AUTHOR]

Introduction: A range of nonpharmaceutical public health interventions has been introduced in many countries following the rapid spread of Covid‐19 since 2020, including recommendations or mandates for the use of face masks or coverings in the community. While the effectiveness of face masks in reducing Covid‐19 transmission has been extensively discussed, scant attention has been paid to the lived experience of those wearing face masks. Method: Drawing on 40 narrative interviews with a purposive sample of people in the United Kingdom, with a particular focus on marginalised and minoritized groups, our paper explores experiences of face mask use during the pandemic. Results: We find that face masks have a range of societal, health and safety impacts, and prompted positive and negative emotional responses for users. We map our findings onto Lorenc and Oliver's framework for intervention risks. We suggest that qualitative data offer particular insights into the experiences of public health interventions, allowing the potential downsides and risks of interventions to be more fully considered and informing public health policies that might avoid inadvertent harm, particularly towards marginalised groups. Patient or Public Contribution: The study primarily involved members of the public in the conduct of the research, namely through participation in interviews (email and telephone). The conception for the study involved extensive discussions on social media with a range of people, and we received input and ideas from presentations we delivered on the preliminary analysis. [ABSTRACT FROM AUTHOR]

Purpose: Secure mental health services in one UK region have acted within a network to develop a range of involvement practices. A new quality benchmarking tool has been created to appraise the implementation of these involvement practices. The purpose of this paper is to report upon a qualitative evaluation of this development. Design/methodology/approach: Staff and service users involved in the co-production of the benchmarking tool were engaged in a series of focus groups and participatory inquiry approaches enacted in the course of scheduled network meetings. Data thus collected was subject to thematic analysis. Findings: Four distinct themes were identified which were titled: Taking time, taking care; The value not the label; An instrument of the network; and All people working together. These are discussed in relation to recent theorising of co-production. Research limitations/implications: Effectively, this study represents a case study of developments within one region. As such, the findings may have limited transferability to other contexts. Practical implications: Staff and service users can work together effectively to the benefit of each other and overall forensic services. The benchmarking tool provides a readymade mechanism to appraise quality improvements. Social implications: Despite a prevailing culture of competition in wider health-care policy, cooperation leads to enhanced quality. Originality/value: The benchmarking tool is a unique development of a longstanding involvement network, demonstrating the positive implications for enacting co-production within secure services. [ABSTRACT FROM AUTHOR]

'Complexity' is theorised as a characteristic of modern food systems that poses a challenge to improving population diets. This paper seeks to explore the discursive deployment of 'complexity' in the context of public health. Doing so helps inform a more critical assessment of commercial and political determinants of health, and of 'complexity' as a prevailing frame for public health issues. Qualitative methods were used to explore 'responsibility' for healthy eating in the food system in the United Kingdom. Discourse analysis was conducted on corporate and government documents, and interviews with industry and government stakeholders. The aim was to examine the implications of 'complexity' within discourses of dietary public health. 'Complexity' was used not only to characterise dietary public health problems but also as a rhetorical device in public health narratives. It performed two main discursive functions: firstly, to represent diet-health problems as so multi-layered and difficult that they are intractable. Secondly, and despite this acknowledged complexity, to deflect from food system actions for improving diet to 'simpler' and non-food interventions, by industry and government. These uses of 'complexity' serve to attribute primary responsibility to individuals for dietary choice and to obscure inaction by government and industry, who have most control over the determinants of those choices. In short, 'complexity' can be used discursively to generate a smokescreen masking policy inaction in addressing public health problems. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present an examination of the development of adult safeguarding policy from the perspectives of both policymakers and those who have sought to influence policy, to empower individuals with a learning disability to have a say in how policies, that influence their life and impact their right to independence, are developed. Design/methodology/approach: This paper is based on a project which was led by a UK-wide interdisciplinary and multi-agency team, which included the central involvement of peer researchers who had lived experience of learning disability. It was based on a participatory disability research design. Findings: Factors which enabled or restrained individuals with a learning disability, and their supporting organisations, from getting their voice heard in policy development, are identified. Originality/value: This paper builds on policy theory and research, making recommendations for policy makers, disabled people and their supporting organisations as to how adult safeguarding policy, could be more effectively informed and influenced. [ABSTRACT FROM AUTHOR]

This paper aims to illustrate the tension between public health and civil liberties through the case study of the UK government's emergency response to the Covid-19 pandemic. In the area of public health, this tension is predominantly approached by reference to two theories: liberalism and communitarianism. This paper studies these positions and how they are manifested in evidence-based policymaking by combining a study of public health policy with a study of public health ethics. The studies help demonstrate the UK government's framing of health policy relating to Covid-19 in terms of liberalism and communitarianism. The paper concludes that in the initial UK government response to Covid-19, the government discourse evoked communitarian values and framed its policies as being evidence-led and as prioritising public health. However, the policy measures themselves manifested liberal values: they had the underlying concern of not infringing excessively on civil liberties, and individuals were given autonomy of decision making within the measures that were taken. The article concluded that emergency times require a communitarian response based on preventative action. This article is the first to combine public health policy with public health ethics to demonstrate how values form a key part of decision making. [ABSTRACT FROM AUTHOR]

This paper is based on Shalini Weerasooriya's Masters dissertation in Public Health at the University of Sheffield. A literature review was conducted to understand the role that orphan drug policies have played in the development of new treatments for rare diseases. The impacts of the policies were categorised as 'tangible' or 'intangible' and further synthesis identified 10 main themes such as incentives for investment, criteria for eligibility and assessment of drug applications and further guidance to industry during the drug development cycle. The review concludes that whilst policies have contributed positively towards improving the research and development of orphan drugs it has not exhausted its uses and must now shift its focus to facilitating greater accessibility and affordability of the treatments and that stakeholders are essential to the success of this process. Implications for practice are identified, for example the need to further update and refine the policy with changing demographics and advancing technologies and, in particular, greater collaboration and involvement through, for example, evidence based training programmes is recommended. It is concluded that focus must shift to address the gap between having available drugs and being able to access and afford them. F.J. [ABSTRACT FROM AUTHOR]

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Global health donors increasingly embrace international non-governmental organisations (INGOs) as partners, often relying on them to conduct political advocacy in recipient countries, especially in controversial policy domains like reproductive health. Although INGOs are the primary recipients of donor funding, they are expected to work through national affiliates or counterparts to enable 'locally-led' change. Using prospective policy analysis and ethnographic evidence, this paper examines how donor-funded INGOs have influenced the restrictive policy environments for safe abortion and family planning in South Sudan and Malawi. While external actors themselves emphasise the technical nature of their involvement, the paper analyses them as instrumental political actors who strategically broker alliances and resources to shape policy, often working 'behind the scenes' to manage the challenging circumstances they operate under. Consequently, their agency and power are hidden through various practices of effacement or concealment. These practices may be necessary to rationalise the tensions inherent in delivering a global programme with the goal of inducing locally-led change in a highly controversial policy domain, but they also risk inciting suspicion and foreign-national tensions. [ABSTRACT FROM AUTHOR]

This paper summarizes key shifts in judicial decisions relating to public health powers during the pandemic and the implications of those decisions for public health practice. Then, it gives a preview and call for partnership in developing a legal framework for authority that guides public health to better activities, processes, and accountability in service of the public's health. [ABSTRACT FROM AUTHOR]

Talking about death and dying is promoted in UK health policy and practice, from a perception that to do so encourages people to plan for their end of life and so increase their likelihood of experiencing a good death. This encouragement occurs alongside a belief that members of the public are reluctant to talk about death, although surveys suggest this is not the case. This paper describes findings from a research study in which people participated in deliberative discussion groups during which they talked about a range of topics related to death, including talking about death, the good death, choice and planning and compassionate communities. Here we report what they had to say in relation to talking about death and dying. We identified three themes: 1. The difference between talking about death as an abstract concept and confronting the certainty of death, 2. how death and dying presents issues for planning and responsibility, and 3. approaches to normalising death within society. For our participants, planning was considered most appropriate in relation to wills and funerals, while dying was considered too unpredictable to be easy to plan for; they had complex ideas about the value of talking about death and dying. [ABSTRACT FROM AUTHOR]

Support for informal dementia care at a local community level is not working for most carers today. Carers looking after a person with dementia have long lamented the absence of an empowered named support and an effectively actioned care plan. Drawing on literary writing and social research, we argue in this article that these challenges have existed since dementia emerged as a major condition in the West during the 1980s. Based on this historical context, we ask: Why has this issue persisted over the last four decades? How have healthcare politics and policy initiatives responded to these requests? And what can we learn from this for the current, COVID-19 exacerbated crisis of care? This article focuses on the English context, to discuss these ongoing challenges in the light of a series of policy papers, and to ask what is hampering the implementation of such policy initiatives. In England, local authorities are responsible for dementia support. This article focuses on the situation in a county in the Midlands where one of us (AB) has been lobbying local government for over a decade. The discussion contextualises the lived experience of dementia care within the situation exacerbated by the COVID-19 pandemic, ensuing politics of crises and persistent emphasis on cure over care. We find that the absence on two points centrally challenges care: a joined-up approach between health and social care and adequate information on available care support services, accessible through an empowered named contact. To enhance the lived experience of dementia care, consistent provision of individual named support and professional care support, as and when required, should become essential to local implementation of the care policy. [ABSTRACT FROM AUTHOR]

Generating negative news coverage of state welfare provision has been identified as a strategy designed to create public support for radical policies aimed to reduce such provision. To date, research of this kind has focused on scandals and crises. However, little is known about the complex relationship between media representations of specific events, and those of media representations in the lead up to these events, what we refer to as periphery representations. Employing a content and frame analysis, this paper analyses the frequency and intensity of peripheral representations of the National Health Service (NHS) in the British print media for 1 week a month before and for 1 week during three key events in recent NHS history: the official consultation period for the Health and Social Care Act; the publication of Five-Year Forward View, and the first Junior Doctor Strike. This article finds that negative NHS representations in articles that are peripheral to particular topical issues of controversy evidence fluctuations, amplifications and intensities across time periods, depending on the particular context. The paper concludes by arguing that repetition of negative themes in news helps to build a sensibility of 'inadequacy' of vital services. We hope that this focus on the ways in which amplifications and de-amplifications in negative intensity of peripheral NHS representations across time and content, helps to contribute to debate about the complex interplay between public health services, media representation and policy consent. [ABSTRACT FROM AUTHOR]

A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence‐based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public sector in England and Wales. In this context, a grandfather clause is included when NICE does not recommend treatment with a given technology. The grandfather clause provides an exemption from the general recommendation for patients who have already started treatment with the technology in question, before the publication of the NICE guidance. In this paper we first lay out the contexts in which grandfather clauses occur in NICE guidance, and then consider ethical arguments against and in support of grandfather clauses and the continuation of treatment. We argue that NICE's current practice of automatic inclusion of a grandfather clause is ethically problematic and unfair. While the inclusion of a grandfather clause may be appropriate and justified in specific cases, we argue that inclusion of such a clause should be considered as part and parcel of the decision making process on a case by case basis, rather than adopted as the default. [ABSTRACT FROM AUTHOR]

This paper offers a five‐part framework for assessing why the United Kingdom has coped poorly compared with peer countries with the medical, social and economic challenges brought by the COVID‐19 pandemic – a surprising failure, given the strength of its scientific community and the internationally attested quality of its civil service. The paper also offers a proposal for how to shape an independent inquiry, one promised by the UK Prime Minister, of the kind that has the primary motivation to better prepare the country for future crises. The paper begins by providing various metrics that set out how the UK has, as of late 2020, been particularly adversely affected by the pandemic. It then details the five‐part framework, which is presented as a series of propositions with initial supporting evidence that require more thorough investigation, supported by a fuller record of evidence. First, we suggest that there have been problems as to how evidence about the pandemic and its anticipated effects was collected, processed and circulated, weakening policymakers' ability to evaluate the risk calculus. Second, particular structures and processes of government decision‐making appear to have been inadequate and ill‐suited to the multidimensional challenges brought by the pandemic. Third, the role of political leadership and decision‐making in the public health and broader policy responses needs thorough evaluation. Fourth, we assess some aspects of economic policymaking during the pandemic. Fifth, features of the UK's institutional make‐up may have been a driver of the suboptimal outcomes. Overall, we argue that UK policymakers may have over‐relied on the medical sciences at the expense of other (social) scientific evidence. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the link between age discrimination and the injustices that have taken place in our care homes during the COVID-19 pandemic in this country. It seeks to show how destructive age discrimination is to those who live in our care homes and attempts to shake up our attitudes to older people, as the pandemic continues. It is hoped that shifts in attitude would lead to a societal revolution in care and support for older people as the pandemic shows us how the current system is breaking down. Design/methodology/approach: This is a personal insight into the plight of the care home sector during the COVID-19 pandemic in the UK. The writer has worked in the field of social care and older people's services for many years and felt compelled to share her learning and observations. This led to venturing more deeply into understanding why those who live, work and visit care homes have been so neglected and "cast into the shadows" in the face of such desperate danger. Whilst tracking the media narrative during the first wave, she attempts to apply her knowledge, in particular gained from working for Help the Aged (now Age UK) as a policy manager for Quality Care, but also draws on experiences as a social worker, commissioner and care provider from the 1980's to the present. By "shining a light" on care homes, revealing that the darker practices that have taken place contravene the Human Rights Act 1998, it is hoped that the recognition of age discrimination will happen at every level and become better known in its application. The paper observes how deeply rooted it is in us all. Findings: Having highlighted some shocking examples of bad practice from the authorities relating to care homes, the article concludes that Government policy on care homes from March to July 2020 was discriminatory and questions how far lessons have been learned. The legislation is in place in the form of the Human Rights Act 1998 to protect older people in care homes but is not being widely implemented at regional policy level. Government rhetoric remains far from reality Instead of redressing the gap and admitting mistakes, there is evidence at a high level of continued denial and the projection of blame on to the care homes themselves. Originality/value: The author's professional background includes meeting the founder of the Gray Panthers, Maggie Kuhn, in the United States in the 1988. This was a defining moment that gave her an original insight into age discrimination and influenced her entire career. It eventually led to her working in national policy for one of the most influential charities for older people at the turn of the millennium, Help the Aged. Here, she co-founded the My Home Life Programme (promoting quality of life in care homes). The paper offers a unique insight into why it is so challenging to achieve quality of life for older people needing care and should be of interest to policymakers, clinical commissioning groups, local authorities, older people's care providers and carer and user organisations. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects.Design/methodology/approach The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions.Findings The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities.Originality/value This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated. [ABSTRACT FROM AUTHOR]

Asset-based thinking is increasingly prevalent in health policy and is to be found also in discourses on social care. This article explores and critiques the applicability of asset-based approaches to social care for older people, using Carol Bacchi's analytical framework to consider developments in the United Kingdom especially. The problem construction, assumptions and suggested solutions underpinning an asset-based approach are considered in turn. The paper draws two major conclusions. The first is that, while it has potential application to the field, the key assumptions and objectives of the asset-based approach do not hold well for social care and therefore adopting the approach carries risks. The paper concludes, secondly, that an asset-based approach is ‘over-promised’ in the sense of being insufficiently theorised and lacking empirical evidence. A number of suggestions are made for greater critical interrogation, improved empirical evidence and closer scrutiny of the policy ‘solutions’ associated with assets-related thinking. [ABSTRACT FROM AUTHOR]