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This paper critically examines the White Paper, Opportunity for all, published by the UK Government's Department for Education (DfE) in March 2022. This has a number of recommendations for schools in an attempt to 'level up'. In particular, there is a promise to deliver 'a fully trust-led system with a single regulatory approach [and] a clear role for every part of the school system'. Such a system provides a serious challenge to the way that Religious Education (RE) structures in England are currently built: in short, when Local Authorities no longer have schools under their control – what is the point of a SACRE? Arguing that the 'local settlement' for RE serves two purposes – a curricular purpose and support and monitoring purpose – this paper will suggest that future RE curricula will be planned at the Trust level, with the monitoring and support functions being moved from the local to the regional. [ABSTRACT FROM AUTHOR]

This paper firstly presents Statement Archaeology, an innovative and rigorous method devised to systematically operationalise the approach to historical exploration used by Michel Foucault in pursuit of the question "how do certain practices become possible at particular moments in history?" Drawing on an analysis of the theoretical basis of Foucault's broad – and arguably equivocal – approach, a series of methodological procedures by which it can be systematically operationalised are set out. These focus on the interrogation of "statements", through a series of questions, against three criteria: Formation, Transformation, and Correlation. Secondly, through the use of a specific policy development in English Religious Education as an exemplar, the paper establishes the potential of the approach. Deploying Statement Archaeology in relation to this example reveals that the change under investigation became possible at a nexus of changes in the rules of what is thinkable and unthinkable within different domains of discourse, and complex and messy processes of changing legitimacies and normalisations, with previously unacknowledged policy-influencers playing an important role. Many existing accounts of this change have overlooked these matters. The paper concludes by arguing that Statement Archaeology has potential significance in any domain of enquiry that seeks answers to the question "how did this particular practice become possible at that particular moment?" [ABSTRACT FROM AUTHOR]

This paper outlines the findings of an empirical research study exploring how early years settings support under-threes with their early reading development in England. The data was collected through a mixed methodological approach of a survey (n = 60 respondents), five semi-structured interviews and two focus group workshops to explore the experiences of Early Years Educators (EYEs) working with under-threes, analysed using Schreier's (2012) thematic analysis of coding maps. The main purpose of this research study was to find out what EYEs do with under-threes to support early reading and why. This paper seeks to acknowledge where children's voices and their choices are included in educational settings' early reading policies, and at what point. The data provides some original insights, especially for the under-threes in this study. The data suggests that when it comes to under-threes and early reading, there is no space for their voices to be included, alongside the wider neoliberal reading attainment agenda. This small-scale study offers a distinct contribution to the field of research into early reading with the emphasis on under-threes. This research may be utilised to review ethical pedagogical approaches to early reading policy development and to reflect further on provision for under-threes. [ABSTRACT FROM AUTHOR]

Background: A lifelong gluten-free diet is the only treatment for coeliac disease. The cost and availability of gluten-free substitute food (GFSF) remain challenging. Some local areas in England have stopped gluten-free prescriptions for coeliac disease. The aim of this paper is to present the quantitative findings of the financial impact of prescription withdrawal on people with coeliac disease. Methods: A cross-sectional survey with adults in England who reported having been diagnosed with coeliac disease by a health professional. The postal survey was distributed by Coeliac UK to their members in 13 prescribing and 13 non-prescribing local areas that were matched for geographical location and level of deprivation. Additionally, an advertisement for the survey was placed on social media. The questionnaire contained items on the availability and use of prescriptions; the weekly amount spent on GFSF; amount of specific GFSF bought; affordability of GFSF; demographics and health-related variables. Data were analysed by descriptive statistics, analysis of variance and regression analysis. Results: Of the 1697 participants, 809 resided in areas that provided prescriptions and 888 in non-prescribing areas. Participants self-report of their prescription did not always match the local area prescription policy. There was no statistically significant difference between prescribing and non-prescribing areas in how easy or difficult participants found it to obtain GFSF (p = 0.644) and its availability in various locations. Participants in non-prescribing areas purchased most types of GFSF items in statistically significantly higher quantities and thereby spent an additional £11.32/month on GFSF items than participants in prescribing areas (p < 0.001). While taking into account the self-reported prescription status, the amount increased to £14.09/month (p < 0.001). Although affordability to buy GFSF did not differ based on local area prescription policy or self-reported prescription status, it was dependent on equivalised annual income. However, affordability did not influence spending on GFSF. Regression analysis indicated that males and households with additional members with coeliac disease spent more on GFSF. Conclusions: The study has highlighted that gluten-free prescription withdrawal can have financial implications for people with coeliac disease. Any future changes to the prescription policy of GFSF should consider the impact on the population, especially lower income households. [ABSTRACT FROM AUTHOR]

Teaching children to read is one of the most fundamental goals of early years and primary education worldwide, and as such has attracted a large amount of research from a range of academic disciplines. The aims of this paper are: (a) to provide a new critical examination of research evidence relevant to effective teaching of phonics and reading in the context of national curricula internationally; (b) to report new empirical findings relating to phonics teaching in England; and (c) examine some implications for policy and practice. The paper reports new empirical findings from two sources: (1) a systematic qualitative meta‐synthesis of 55 experimental trials that included longitudinal designs; (2) a survey of 2205 teachers. The paper concludes that phonics and reading teaching in primary schools in England has changed significantly for the first time in modern history, and that compared to other English dominant regions England represents an outlier. The most robust research evidence, from randomised control trials with longitudinal designs, shows that the approach to phonics and reading teaching in England is not sufficiently underpinned by research evidence. It is recommended that national curriculum policy is changed and that the locus of political control over curriculum, pedagogy and assessment should be re‐evaluated. The video abstract for this article is available at https://youtu.be/bJImJ79JKNI. Context and implicationsRationale for this studyTeaching children to read is one of the most important elements of primary education because it is fundamental to children's educational development. For this reason it is vital that the teaching of reading, and curriculum policies on reading, are informed by robust research.Why the new findings matterIf children are not being taught to read in the most appropriate way, because curriculum policy and teaching practices are not informed sufficiently by robust research evidence, then children's education will not be as effective as it should be.Implications for practitioners, policy makers, researchersThe outcomes of the survey of teachers in England, and the new analysis of systematic reviews and meta analyses, and randomised controlled trials with longitudinal designs, reported in the paper show the need for changes to the teaching of reading and to national curriculum policy on the teaching of reading.The teaching of phonics and reading in curriculum policy and practice should more closely reflect the evidence that contextualised teaching of reading, or balanced instruction, is the most effective way to teach reading. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the prevalence, motivations and support for student sex work within North East higher education institutions. With limited existing research in this area, this study fills a crucial gap in understanding student sex work in the UK and its specific manifestation in the North East region. Design/methodology/approach: To achieve its objectives, this study adopted an exploratory, cross-sectional design conducted entirely online due to the Covid-19 pandemic. A mixed-methodology approach was used, inspired by previous research, gathering quantitative data through a semi-structured questionnaire and qualitative data through open-ended survey questions. Findings: The study revealed that 11.4% of students engaged in sex work, primarily in indirect and online-based forms. lesbian, gay, bisexual and transgender (LGBTQ)+ students were more likely to participate in sex work compared to heterosexual students. Financial difficulties and lifestyle preferences were identified as significant motivations for student sex work. Research limitations/implications: A limitation of the study was the lack of diversity in the sample, with predominantly young, white, heterosexual and cis-gender females, potentially neglecting other demographics' struggles. Future research should include larger and more diverse samples to ensure representative findings. Practical implications: The research highlights the need for greater awareness and support for student sex workers within North East universities. Policies and services should consider the unique challenges faced by LGBTQ+ student sex workers to reduce stigma and potential dangers. Social implications: Understanding the prevalence of student sex work sheds light on the need to challenge societal assumptions and stigmas surrounding sex work, particularly concerning gender and sexuality. Originality/value: This study breaks new ground by providing novel insights into an understudied research area – the prevalence of student sex work in North East England. The findings lay the foundation for future research and can inform policies and support systems to improve the safety and well-being of student sex workers. Furthermore, the study contributes to broader discussions on gender, sexuality and sex work in academic settings. [ABSTRACT FROM AUTHOR]

This paper, a critical examination of educational concepts, policies and practices, presents findings from research into the impact of accountability agendas on teacher professionalism and pedagogic practices. The study, theoretically framed through Halstead's notions of contractual and responsive accountability, and Gramsci's hegemonic practices, examined secondary arts teachers' pedagogical autonomy and professionalism in England and New Zealand. We provide an overview of current education policy contexts in both countries, and their impact upon secondary school arts education (years 11–16). Drawing from interview data from 15 England and New Zealand teachers, we offer a critique and innovative counter-narrative for the accountability measures currently dominating English schooling. Drawing together perspectives from both jurisdictions, we suggest more inclusive, democratic and responsive assessment and performative measures for the English context. [ABSTRACT FROM AUTHOR]

In recent years many countries have created national bodies that provide evidence-based guidance and policy relating to the commissioning and provision of healthcare services. However, such guidance often fails to be consistently implemented. The differing perspectives from which guidance is developed is suggested as a significant contributor to these failures. A societal perspective is, necessarily, taken by policy makers, while patients and their healthcare professionals are primarily concerned with an individual perspective. This is particularly likely to impair implementation where national policy objectives, such as cost effectiveness, equity, or the promotion of innovation, are embodied in the guidance, while patients and healthcare professionals may consider it appropriate to over-ride these, based upon individual circumstances and preferences. This paper examines these conflicts with reference to guidance issued by the National Institute of Health and Care Excellence in England. Conflicts are identified between the objectives, values, and preferences of those who develop and those who implement such guidance, with consequent difficulties in providing helpful personalised recommendations. The implications of this for the development and implementation of guidance are discussed and recommendations are made regarding the ways in which such guidance is framed and disseminated., Competing Interests: Declaration of Competing Interest Both authors declare funding from the NIHR Programme Development Grants Programme (NIHR202042). JM has previously chaired a National Institute of Health and Care Excellence (NICE) Guideline Development Group and been vice chair of the NICE Appraisals Committee., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

The problem of low attainment in mathematics has been an increasingly prominent feature of the policy discourse in England over the last 60 years; however, evidence from comparative studies indicates that little progress has been made in finding a solution. In this paper, we analyse the changing policy discourse of low attainment in mathematics through the main reports and speeches published in England, beginning with the Newsom Report, Half Our Future, in 1963, and continuing to the present day. We chart the evolving perspectives on the nature of ability, expectations, curriculum ideology and frame of reference through the changing language used in these documents, noting tensions and inconsistencies which arise through continuing lack of clarity about definitions and assumptions. [ABSTRACT FROM AUTHOR]

Classroom music teachers in England design their own music curricula for Key Stage 3 (11 − 14 year olds, 6th – 8th Grades). These curricula are designed in a context where policymakers define, regulate and legitimate curriculum formulations. This study traced curriculum development in England, where government has validated a policy driven approach. It explored programs of study, which music teachers in England design as summaries of musical learning for Key Stage 3. The research consisted of documentary analysis in a two-phase study of 13 secondary (high) schools in the English midlands, exploring musical knowledge for musical learning, which is analyzed utilizing qualitative and quantitative methodologies. The paper concludes with a discussion which explores the impacts of music education policy on classroom practices, and presents a proposed model which captures this interaction. [ABSTRACT FROM AUTHOR]

Aims: The United Kingdom and Australia have developed highly divergent policy responses to electronic nicotine delivery systems (ENDS). To understand the historical origins of these differences, we describe the history of tobacco control in each country and the key roles played in setting ENDS policy in its early stages by public health regulations and policy networks, anti‐smoking organizations, 'vaper' activist networks and advocates of harm reduction policies towards injecting drug use. Methods: We analysed key government reports, policy statements from public health bodies and non‐government organizations (e.g. cancer councils and medical organizations) on ENDS; submissions to an Australian parliamentary inquiry; media coverage of policy debates in medical journals; and the history of tobacco control policy in Australia and England. Key discourses about ENDS were identified for each country. These were compared across countries during a multi‐day face‐to‐face meeting, where consensus was reached on the key commonalities and divergences in historical approaches to nicotine policy. This paper focuses on England, as different policy responses were apparent in constituent countries of the United Kingdom, and Scotland in particular. Results: Policymakers in Australia and England differ markedly in the priority that they have given to using ENDS to promote smoking cessation or restricting smokers' access to prevent uptake among young people. In understanding the origins of these divergent responses, we identified the following key differences between the two countries' approaches to nicotine regulation: an influential scientific network that favoured nicotine harm reduction in the United Kingdom and the absence of such a network in Australia; the success of different types of health activism both in England and in Europe in opposing more restrictive policies; and the greater influence on policy in England of the field of illicit drug harm reduction. Conclusions: An understanding of the different policy responses to electronic nicotine delivery systems (ENDS) in England and Australia requires an appreciation of how actors within the different policy structures, scientific networks and activist organizations in each country and region have interpreted the evidence and the priority that policymakers have given to the competing goals of preventing adolescent uptake and encouraging smokers to use ENDS to quit smoking. [ABSTRACT FROM AUTHOR]

Modern Foreign Language (MFL) education has long been described as being 'in crisis' by virtue of a long decline in the numbers of students being entered for exams at age 16 and 18. Whilst this decline is generally attributed to policy, harsh grading and the rise of global English, this paper challenges this view by positioning the decline at the intersection of the feminising of the subject and an othering of the speakers of the languages taught. Using a loosely Foucauldian form of discourse analysis, academic literature, published reports on language needs and language teaching, and original qualitative data from two studies are drawn together. A feminising discourse around the subject of MFL is identified, juxtaposed with a masculinising discourse around education more generally, leading to the devaluing of the subject. Edward Said's orientalism is explored as a framework for the discussion of the media and public 'othering' of the speakers of the languages commonly taught and the 'fetishisation' of less commonly taught languages. It is argued that overcoming the decline in uptake of modern foreign languages will require reconceptualising of the problem at policy level and a change in the media and public discourses surrounding the subject. [ABSTRACT FROM AUTHOR]

The importance of key legislation in framing religious education in England is widely assumed, and indeed some argue that these Acts – of 1870, 1944 and 1988 – demarcate pedagogical phases, or paradigms. Policy and historical analyses have revealed the political and social disputes around legislation, but often conflate legislation with other policy. This paper reassesses the statutory meanings of 'religious education' through a textual analysis of legislation from 1800 onwards, exploring: the positive entitlement to religious education; the negative freedom not to be subjected to other forms of religious education; curriculum specifications. Sixty-five Acts were reviewed. Presented chronologically, the analysis shows that: the term has a long and varied development that predates compulsory education; several neglected Acts have been pivotal in shaping the subject – notably in 1841, 1869 and 1936; religious education is continuously a marker of religious autonomy for individuals and increasingly for schools, and its curricular use stems from this; the newest related terms are for inspection purposes. The implications are discussed for accounts of the subject, curriculum development and further research, both in England and more widely. [ABSTRACT FROM AUTHOR]

In a neoliberal era of education, there has been a shift of policy focus to performativity and evidence-based practice, coupled with neoconservative ideology of a more traditional knowledge-led curriculum. The resultant, extant education policy context has received criticism due to its teach to test culture, the concomitant narrowing of curriculum and the highly prescribed, scrutinised and 'authorised' pedagogic practices prevalent in schools. The paper draws on empirical qualitative data from three modern foreign languages (MFL) secondary school teachers in high poverty contexts in the North West of England. The study examines how these teachers describe their pedagogical practice within the confines of the current policy landscape and how they respond to curriculum and assessment requirements. The paper concludes that, despite the limiting effects of the prescriptive approaches in the current educational system, there are opportunities for teachers to promote unauthorised pedagogies in their classrooms that respond to their specific contexts. However, it acknowledges a shift in teachers' professional identity and questions the current discourses associated with teachers' professional knowledge. In response to this, I call for better recognition of the politicised and antidemocratic nature of current education policy and for us to equip teachers to become public intellectuals with the professional confidence to act for social change by reclaiming pedagogic discourses and practices that benefit pupils living in poverty. [ABSTRACT FROM AUTHOR]

The focus of this research paper was to explore the early years practitioners’ perspectives on supporting children with English as an Additional Language in England. Using qualitative research methods, underpinning theories, a systematic literature review and personal reflective journal, the research study aimed to highlight the importance of supporting children learning English as an Additional Language through using the parents and community and ecological systems (Bronfenbrenner, 1977) without making one language ‘better’ than the other. The findings of the study revealed the need of systematic reviews in legislation, policies, funding and training for the practitioners. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic suspended established practices that, in normal times, are seen as central to the functioning of education systems. For example, in England, school closures led to the cancellation of national examinations in 2020, and their attempted replacement with an algorithmic model. Following public outcry about what were seen as the unjust effects of the application of that model, there was a very public policy reversal, and examination grades were awarded on the basis of moderated teacher assessments or Centre Assessed Grades, resulting in substantial grade inflation. This paper draws on research that investigated the actors involved in examinations policy in this period and focuses especially on the sources of expertise and the kinds of knowledge that were mobilised - or not - in the decision to cancel examinations, to develop the algorithm and to revert to Centre Assessed Grades. [ABSTRACT FROM AUTHOR]

This paper explores the nature of climate change education-related policy influence in England at a time when public consciousness about the need to accelerate climate change action was heightened, and as the 2018 climate strikes gathered momentum around the world. Informed by Foucault's concept of 'governmentalities', and using data generated through 24 exploratory interviews and reflexive thematic analysis, we examine the extent to which influential individuals were advocating for policy change. We discuss the nature of policy influence with particular reference to the 'stances' that individuals adopted relative to climate change education policy influence and noting a common tendency exhibited amongst participants which was a tendency towards 'deference'. Coupling our insights with theorisations of dissent, we consider how 'infra-political dissent' could support key individuals to 'step up' and influence for more effective policy relative to climate change education, and to other areas of education or environment policy. [ABSTRACT FROM AUTHOR]

This paper presents a comprehensive overview of the recording, reporting, and use of data pertaining to school attendance and absence in England. To establish a foundation, we outline the educational context in England, alongside an explanation of the legal framework guiding the collection and use of attendance and absence data. Subsequently, we elucidate the definition and documentation of various types of absence in England, the methodologies employed for data collection and dissemination, as well as the utilisation of this data for benchmarking purposes. Notably, attendance serves as a key performance indicator for schools, Trusts, and Local Authorities, aiming to improve the educational outcomes of young people. Through a critical examination of the current policy and practice in England concerning data on school attendance and absence, we identify strengths and weaknesses. Based on our findings, we propose additional actions to improve the consistency of data collection and foster the effective reporting and use of data to support prompt responses as needed. Through these suggestions, our endeavour is to drive continuous improvement and optimise outcomes for young people in England. [ABSTRACT FROM AUTHOR]

About a quarter of the adults living in England have been diagnosed with a mental health condition (for example, anxiety and depression). The purpose of this paper is to discuss the difficulties faced by these people when they travel, and ways in which policy interventions could be used to encourage them to travel more. The main evidence in the paper comes from a weighted sample of 363 people with mental health conditions who completed an on-line survey. The paper concentrates on anxiety issues. The anxieties are considered under five headings: interacting with fellow travellers, interacting with staff and purchasing tickets, wayfinding, needing support, and needing to take urgent action. Policy interventions to improve access to infrastructure and services to help address the anxieties are discussed under these headings. The number of respondents who say that they would travel more if some of the interventions were introduced is then considered. The paper concludes that there are ways in which some of the anxieties that people have when travelling can be addressed and that introducing these types of intervention would increase travel by people with mental health conditions. • Psychological barriers to travel are revealed in an on-line survey. • 99% of the respondents identified aspects of travel that caused them anxiety. • The largest cause of anxiety was interacting with other people when travelling. • Other causes of anxiety included wayfinding and needing to find public toilets. • Policy interventions would encourage the respondents to travel more. [ABSTRACT FROM AUTHOR]

A correction to a paper printed in a prior issue is presented, written by Berridge et al., which discusses policy around electronic nicotine delivery systems.

Prison settings have been neglected in the growing literature on drug-related deaths. This paper explores policy and practice issues regarding the governance of drug-related deaths in prisons in England and Wales from 2015-2021. Thematic documentary analysis was conducted on national level policy documents published between 2015-2021 (e.g. drug strategies, prison policy documents, Her Majesty's Inspectorate of Prisons and Prison and Probation Ombudsman (PPO) annual reports and guidance for staff). At the local (prison) level, all of the PPO fatal investigation reports and their associated action plans relating to 171 drug-related deaths from 2015-2021 were analysed thematically. Various modes of governance were identified using Head's 'wicked problems' conceptual framework including avoidance and denial, coercive controls, compartmentalised micro-management, incremental and pragmatic adjustment and technocratic problem-solving. There was strong evidence of the dominance of denial of the problem of drug-related deaths, coercive controls, micro-management and reliance on technological solutions in the early years (2015-2018). In some prisons, there developed a move towards the adoption of more pragmatic and incremental policies and push towards comprehensive policies over time. In others, remnants of denial and coercion remained. In our analysis, the focus on new psychoactive substances came to dominate attention, to the relative neglect of other substances and of the contribution of mental and physical illness to these deaths. Staff are not equipped, supported or resourced adequately to deal with the two 'wicked problems' of increasing rates of drug use and mental illness which collide in the prison setting. The PPO investigations repeatedly recommend reducing supply and improving monitoring and surveillance and the emergency response. There is less focus on prevention and reducing demand or improving the wider environmental context and culture in which the deaths occur. Policy needs to pay more attention to the fundamental issues driving the current deterioration in conditions in prisons. [ABSTRACT FROM AUTHOR]

Background: The Ambitions for Palliative and End of Life Care is a national framework for local action in England co-produced by over 30 partners; little research has been conducted on how the Framework is received and used. This study sought to examine and support how people understand, interpret, and implement the Framework. Methods: A multi-stage qualitative methodology involving four stages of data collection: (1) case study interviews, (2) focus groups, (3) interactive workshops, and (4) Evidence Cafés. From initial interviews, ongoing thematic data analysis informed the design and focus of subsequent stages as part of a process of knowledge transfer. Results: A practical resource to support service provision and development was produced; a grab-and-go guide called "Small Steps, Big Visions". It focuses on the eight foundations in the Ambitions Framework, with additional guidance on collaboration and partnership working, and sharing learning. Each foundation is presented with a 'what' (definition), 'ask' (prompt questions), and 'examples in action' (drawn from case studies). Conclusions: Research can contribute to policy implementation to advance palliative and end of life care. The engagement and input of those responsible for implementation is key. [ABSTRACT FROM AUTHOR]

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]

Background: Significant health inequalities exist in England. Primary care networks (PCNs), comprised of GP practices, were introduced in England in 2019 with funding linked to membership. PCNs have been tasked with tackling health inequalities. Aim: To consider how the design and introduction of PCNs might influence their ability to tackle health inequalities. Design and setting: A sequential mixed-methods study of PCNs in England. Method: Linear regression of annual PCN-allocated funding per workload-weighted patient on income deprivation score from 2019–2023 was used. Qualitative interviews and observations of PCNs and PCN staff were undertaken across seven PCN sites in England (July 2020–March 2022). Results: Across 1243 networks in 2019–2020, a 10% higher level of income deprivation resulted in £0.31 (95% confidence interval [CI] = £0.25 to £0.37), 4.50%, less funding per weighted patient. In 2022–2023, the same difference in deprivation resulted in £0.16 (95% CI = £0.11 to £0.21), 0.60%, more funding. Qualitative interviews highlighted that, although there were requirements for PCNs to tackle health inequalities, the policy design, and PCN internal relationships and maturity, shaped and sometimes restricted how PCNs approached this task locally. Conclusion: Allocated PCN funding has become more pro-poor over time, suggesting that the need to account for deprivation within funding models is understood by policymakers. The following additional approaches have been highlighted that could support PCNs to tackle inequalities: better management support; encouragement and support to redistribute funding internally to support practices serving more deprived populations; and greater specificity in service requirements. [ABSTRACT FROM AUTHOR]

In this article, we examine how policy documents from three European countries – the Netherlands, Germany and England – position a key outcome of higher education: the development of high-level professionals. Our findings show significant differences between the policies in the three countries in terms of in definitions of high-level professionals, the characterization of the education needed to produce high-level professionals, and the mechanisms identified as ensuring the production of high-level professionals. Our findings show that in order to develop a comparative understanding of higher education outcomes across the European Higher Education Area (EHEA), it is necessary to examine the strategic and visionary perspective of national policies in different EHEA countries. This is significant given that the EHEA's claim to ensure common outcomes across its higher education systems. [ABSTRACT FROM AUTHOR]

Background: Patient demand, internationally, on emergency departments and urgent care treatment centres has grown. Shortages of staff, particularly of emergency medicine doctors, have compounded problems. Some countries are pursuing solutions of including non-medical practitioners e.g., nurse practitioners and physician associates/assistants in their emergency department workforces. This study investigated at the macro and meso level of the health system in England: what the rationale was and the factors influencing the current and future employment, or otherwise, of non-medical practitioners in emergency departments and urgent treatment centres. Methods: Mixed qualitative methods in the interpretative tradition were employed. We undertook, in 2021–2022, a documentary analysis of national, regional and subregional policy (2017–2021), followed by semi-structured interviews of a purposive sample (n = 18) of stakeholders from national, regional and subregional levels. The data were thematically analysed and then synthesised. Results: There was general national policy support for increasing the presence of non-medical practitioners as part of the solution to shortages of emergency medicine doctors. However, evidence of policy support dissipated at regional and subregional levels. There were no published numbers for non-medical practitioners in emergency departments, but stakeholders suggested they were relatively small in number, unevenly distributed and faced uncertain growth. While the experience of the COVID-19 pandemic and its aftermath were said to have made senior decision makers more receptive to workforce innovation, many factors contributed to the uncertain growth. These factors included: limited evidence on the relative advantage of including non-medical practitioners; variation in the models of service being pursued to address patient demand on emergency departments and the place of non-medical practitioners within them; the lack of a national workforce plan with clear directives; and the variation in training for non-medical practitioner roles, combined with the lack of regulation of that level of practice. Conclusions: We identified many features of a system ready to introduce non-medical practitioners in emergency departments and urgent treatment centres but there were uncertainties and the potential for conflict with other professional groups. One area of uncertainty was evidence of relative advantage in including non-medical practitioners in staffing. This requires urgent attention to inform decision making for short- and long-term workforce planning. Further investigation is required to consider whether these findings are generalisable to other specialties, and to similar health systems in other countries. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. Methods: We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. Results: We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. Conclusions: Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability. [ABSTRACT FROM AUTHOR]

Brexit, the withdrawal of the United Kingdom from the European Union, has offered the UK government a unique opportunity to fundamentally reform agricultural policy. In England, the new policy—called Environmental Land Management—will reward farmers for activities that produce environmental public goods, such as clean air and water and a thriving wildlife, and prevent environmental hazards. It could lead to the biggest changes in land management since the end of World War II. This photo essay and the process of making it contributes to a better understanding of how farmers feel about the changes underway. [ABSTRACT FROM AUTHOR]

Biodiversity targets are a key tool, used at a global and national policy level, to align biodiversity goals, promote conservation action, and recover nature. Yet most biodiversity targets are not met. In England, the government has committed to legally‐binding targets to halt and recover the decline in species abundance by 2030 and 2042. We present evidence from recent population trends of 670 terrestrial animal species (for which abundance time series are available) as a species abundance indicator, together with a synthesis of case studies on species recovery, to assess the degree to which these targets are achievable. The case studies demonstrate that recovery is possible through a range of approaches. The indicator demonstrates that theoretically targets can be achieved by addressing severe declines in a relatively small number of species, as well as creating smaller benefits for many species through landscape‐scale interventions. The fact that multiple pathways exist to achieve the species abundance targets in England presents choices but also raises the possibility that targets might be reached with perverse consequences. We demonstrate that evidence on achievability is a necessary but not sufficient condition for determining what is required to deliver conservation outcomes and restore biodiversity. [ABSTRACT FROM AUTHOR]

Background: Predicting the likely size of future SARS-CoV-2 waves is necessary for public health planning. In England, voluntary "plan B" mitigation measures were introduced in December 2021 including increased home working and face coverings in shops but stopped short of restrictions on social contacts. The impact of voluntary risk mitigation behaviours on future SARS-CoV-2 burden is unknown. Methods: We developed a rapid online survey of risk mitigation behaviours ahead of the winter 2021 festive period and deployed in two longitudinal cohort studies in the UK (Avon Longitudinal Study of Parents and Children (ALSPAC) and TwinsUK/COVID Symptom Study (CSS) Biobank) in December 2021. Using an individual-based, probabilistic model of COVID-19 transmission between social contacts with SARS-CoV-2 Omicron variant parameters and realistic vaccine coverage in England, we predicted the potential impact of the SARS-CoV-2 Omicron wave in England in terms of the effective reproduction number and cumulative infections, hospital admissions and deaths. Using survey results, we estimated in real-time the impact of voluntary risk mitigation behaviours on the Omicron wave in England, if implemented for the entire epidemic wave. Results: Over 95% of survey respondents (NALSPAC = 2686 and NTwins = 6155) reported some risk mitigation behaviours, with vaccination and using home testing kits reported most frequently. Less than half of those respondents reported that their behaviour was due to "plan B". We estimate that without risk mitigation behaviours, the Omicron variant is consistent with an effective reproduction number between 2.5 and 3.5. Due to the reduced vaccine effectiveness against infection with the Omicron variant, our modelled estimates suggest that between 55% and 60% of the English population could be infected during the current wave, translating into between 12,000 and 46,000 cumulative deaths, depending on assumptions about severity and vaccine effectiveness. The actual number of deaths was 15,208 (26 November 2021–1 March 2022). We estimate that voluntary risk reduction measures could reduce the effective reproduction number to between 1.8 and 2.2 and reduce the cumulative number of deaths by up to 24%. Conclusions: Predicting future infection burden is affected by uncertainty in disease severity and vaccine effectiveness estimates. In addition to biological uncertainty, we show that voluntary measures substantially reduce the projected impact of the SARS-CoV-2 Omicron variant but that voluntary measures alone would be unlikely to completely control transmission. [ABSTRACT FROM AUTHOR]

This article seeks to understand the challenges of combining the distinct aims of personalisation and integration in adult social care. Addressing the local context of service delivery in England through interviews with key stakeholders, we identify how personalisation and integration activities require different, and potentially conflicting, approaches. We observe direct tensions when structural integration with health systems distracts focus from achieving personalised delivery of care or where a focus on clinical outcomes takes precedence over broader wellbeing aspirations. Integration can entail the prioritisation of health over social care and a population rather than personal orientation. We suggest that personalisation and integration are in 'policy conflict' (Weible and Heikkila, 2017) and that policy-makers need to acknowledge and address this rather than promise the 'best of both worlds'. [ABSTRACT FROM AUTHOR]

Issues of domestic space standards and occupancy levels rarely receive much attention in debates about UK housing and planning policies. This is exemplified by examining the history of space and occupancy standards as applied in England, demonstrating that standards have been under-specified, partial in coverage, and applied inconsistently. The outcomes are seen in the production of relatively small homes, overcrowding and (perversely) extensive under-occupation, residential dissatisfaction and mobility. Evidence for the health and wellbeing impacts of space shortages highlights the consequences for infectious diseases, particularly respiratory illness, mental health and stress, and educational attainment. Moreover, the mediating and moderating roles of domestic space upon the impacts of the Covid-19 pandemic show the crucial importance of space and occupancy standards for health, wellbeing and learning in a future where more time is spent at home. Areas of future research are identified which together could help address a probable underestimate of the current health sector costs of inadequate domestic space, this being an important lever for policy action. Such evidence, including crucially more from the UK itself, has an important role to play if stronger, more effective policies are to be developed and implemented in this area in future. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence has suggested that a person-centred approach (PCA) is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care (EOLC). This article aims to explore the meaning and implications of person-centredness in EOLC policy discourses. Methods: By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how PCA in EOLC is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents released between 2000 and 2019 in these two post-industrial and socio-culturally distinctive countries. Results: Our analysis found that the PCA is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the pol icies both within and between England and Japan. They include ambiguity in defining patients' best interests, fragmented support for social and family care and the neglect of existential needs. Conclusions: This cross-cultural analysis has revealed the complex nature of discourses around PCA in English and Japanese EOLC policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of PCA is needed in EOLC policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences. [ABSTRACT FROM AUTHOR]

Against a backdrop of faith-based alcohol treatment 'filling the gaps' left by long term restructuring of service provision, funding cuts and marketisation of health and social care this paper makes connections between critical geographies of alcohol policy and service-users everyday lives in England and Wales. Presenting ethnographic research I highlight strategies, practices and performances - 'playing the game'- as service users navigate the multi-scalar impacts of 'austerity' policies, rollback neoliberal governance and 'recovery citizenship' focused on notions of vulnerablity, responsibilisation and 'underclass' behavioural politics. More specifically, the study foregrounds 'fitting in'; 'faking it'; 'conspiracy theories'; and/or 'spiritual journeys' to evidence service-users complex and sophisticated knowledges and experiences of contemporary landscapes of alcohol policy and treatment regimes. The conclusion signposts future directions for research. [ABSTRACT FROM AUTHOR]

Background: Global initiatives that promote public health responses to dementia have resulted in numerous countries developing new national policies. Current policy guidelines in England, for example, recommend that people diagnosed with mild-to-moderate dementia receive information and psychosocial interventions to improve their ability to 'live well'. However, it remains unclear to what extent these recommendations are being achieved.Methods: Self-reported information from 1537 people living with dementia and informant-reported information from 1277 carers of people living with dementia was used to quantify receipt of community-based dementia support services, including health and social care services provided by statutory or voluntary-sector organisations, in Britain from 2014 to 2016. Demographic factors associated with differences in receipt of support services were also investigated to identify particularly vulnerable groups of people living with dementia.Results: Both self- and informant reports suggested that approximately 50% of people living with dementia received support services for dementia. Receipt of support services was lower among people living with dementia who are older, female, and have fewer educational qualifications. Receipt of support services also differed according to diagnosis and carer status, but was unrelated to marital status.Conclusions: Limited receipt of dementia support services among people living with dementia in Britain provides a baseline to assess the efficacy of current policy guidelines regarding provision of information and support. Targeted efforts to facilitate receipt of support services among the particularly vulnerable groups identified in the current study could improve the efficacy of dementia support services both in Britain and internationally, and should inform policy development. [ABSTRACT FROM AUTHOR]

This article reports on a case study investigating the micro-politics of policy enactment in a school in England. The case is sited in the literacy policy of a primary school in challenging circumstances as it joins a Multi-Academy Trust (MAT). Data gathering consisted of interviews with the school headteacher, assistant headteacher, and literacy coordinator. Data were analysed thematically using the thinking tools of Bourdieu to understand and explain the micro-politics of the policy enactment. Findings suggest that the enactment of policy in schools in England can be a dynamic undertaking when there is judged a need to improve. The micro-politics of the school may become dominated by the need to comply with MATs and private providers of educational solutions, potentially reducing the autonomy of teachers and headteachers. [ABSTRACT FROM AUTHOR]

The diagnosis of autism can be challenging, particularly if an individual coming for assessment is considered to be near the diagnostic threshold. It is important to understand the experiences and challenges of diagnosis from the perspective of clinicians. In this study, 21 in-depth interviews were conducted with clinicians working in specialist autism assessment teams in adult and children's services in England. Interviews were recorded and transcripts were analysed thematically. We identified four themes that represented how clinicians were frequently engaged with juggling their own professional understanding of what autism is with other factors such as the results of standardised tests and the views of patients and carers, in the context of limited resources: institutional pressure, making diagnosis make sense, seeing through an autism lens and just tools. The study illuminates the diagnostic process as a socially situated activity. We suggest that an examination of the benefits and drawbacks of assessment services specialising in autism only, the resources they require to operate effectively, and how they operate in the context of wider health services would be appropriate and timely. When a child or adult is referred for an autism diagnosis, clinicians from different backgrounds work together to make a diagnostic decision. A few studies have asked clinicians in interview how they feel about diagnosis and what the challenges are. We interviewed clinicians in child and adult assessment services in England, and from different professional backgrounds, about the challenges of autism diagnosis and the factors that might influence the assessment process. We found that there were a number of challenges in autism diagnosis, especially when someone coming for diagnosis was considered to be near the diagnostic threshold. Clinicians told us that making a diagnosis was like creating a 'narrative': looking at many different factors that told a story about a person, rather than just looking at the results of diagnostic tests. Clinicians do not always agree with the results of those tests and have to use their specialist clinical judgement to make decisions. Clinicians were concerned about the amount of time people have to wait for an autism assessment, and the resulting pressure on the assessment process. The findings of this work can help us to understand how diagnosis happens and consider ways in which it can be improved for adults, children and families coming for assessment, as well as clinicians. [ABSTRACT FROM AUTHOR]

Objectives: The Scientific Pandemic Insights group on Behaviours (SPI‐B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid‐19 transmission in the long term. Methods: With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI‐B. The information was collated and refined through discussion with SPI‐B and SAGE colleagues to finalize the proposals. Results: Embedding infection control behaviours in the long‐term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid‐safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid‐safe culture and identity, and providing resources so that all sections of society can build Covid‐safe behaviours into their daily lives. Conclusions: Embedding 'Covid‐safe' behaviours into people's everyday routines will require a co‐ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term. [ABSTRACT FROM AUTHOR]

Introduction: As part of major policy reforms begun in 2010, England introduced a wave of initiatives to encourage more integrated care between health and social care. These built on previous attempts which sought to achieve similar objectives through a focus on better partnership working. This article provides an overview and critical commentary on integrated care policy in England from 2010-2020 based on reviews by regulators, parliamentary committees and the national audit office. Overview of Policy: Integrated care became a priority through the work of the Future Forum, a group of leading stakeholders established due to concerns about greater competition in public health care. This led to a public statement of shared commitment to integrated care by national health and social care bodies. Early mechanisms included a pooled fund to achieve nationally set objectives, the creation of local authority led partnership boards, and high profile innovation programmes. Later in the 2010's, new health led partnerships became more dominant vehicles to achieve integrated care at regional level. Impact of Policy: Despite progress within a few local areas, and reduction in delayed discharges from hospital the overall picture from national reviews was that expected improvements were not achieved. Emergency admissions to hospital continued to grow, patients within primary care reported being less involved in their care, and health inequalities worsened. The initial response to COVID-19 was health-centric contributing to outbreaks in care homes and inadequate supplies of protective personal equipment. The ability of leaders to look beyond their organisations' interests was reported as vital for local progress. National government performance frameworks discouraged system based working and chronic underfunding of social care led to major capacity and workforce challenges. Conclusion: The experience of England suggests that greatest progress is made when integrated care focusses on tangible issues and when there is a clear understanding of how success will be measured. Even with considerable investment and intent progress should be expected to be slow and difficult. Layering of numerous policy initiatives provides confusion and can distract from the important work of relationship building. And ultimately, integrated care cannot by itself address major inadequacies in the underlying resources and structural inequalities. [ABSTRACT FROM AUTHOR]