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Background The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs). Methods A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time. Results A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications. Conclusions The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term. [ABSTRACT FROM AUTHOR]

Across welfare regimes, markets are taking the lead from states in providing public-funded health care. Concurrently, informalization of labor market activity in healthcare provision grows. Through an institutional ethnography of temporary agency and bank labor experiences in the English and Greek National Health Services, this paper unpacks how informalization emerges in political and policy environments that not only favor but also resist market arrangements. In doing so, the paper moves the debate from the dilemma of whether to incorporate market actors in healthcare provision to the comprehensive social policy question of how markets could work in healthcare provision. [ABSTRACT FROM AUTHOR]

Background In April 2020, Covid-19 brought NHS elective procedures to a halt. The aim of this paper is to produce accurate forecasts on the building backlog, highlight the state of waiting lists currently and propose solutions required to prevent a public health crisis. Method Using data published by NHS digital and NHS England on previous years, we have analysed and used this to produce estimates of cancellations and missed cases. We also analyse government data on waiting lists and show compliance or lack of with these. Results We show that compliance with waiting list times pre pandemic was falling year on year (83.2% in 2020 down from 87% in 2019). Every month that passes we estimate that 400 000 cases are not being performed. This may include urgent cancer care work in some trusts. Conclusions Waiting lists have been governed by strict rules since 2004. Given falling compliance with 18-week intention to treat we believe the scale of the backlog combined with NHS capacity diminished due to Covid-19 precautions is a public health crisis waiting to occur. We identify difficulties in resuming elective work and suggest strategies that could be employed to avoid a public health crisis. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue, including the National Health and Aging Trends Study (NHATS), the care of people with dementia, and the trajectories of paid and family care hours of people living with dementia.

Summary: Background: As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self‐examination (SSE); however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE interventions. Objectives: To systematically examine, map, appraise and synthesize, qualitatively and quantitatively, studies evaluating the early detection of skin cancer, using SSE interventions. Methods: This is a systematic review (narrative synthesis and meta‐analysis) examining randomized controlled trials (RCTs) and quasiexperimental, observational and qualitative studies, published in English, using PRISMA and National Institute for Health and Care Excellence guidance. The MEDLINE, Embase and PsycINFO databases were searched through to April 2015 (updated in April 2018 using MEDLINE). Risk‐of‐bias assessment was conducted. Results: Included studies (n = 18), totalling 6836 participants, were derived from 22 papers; these included 12 RCTs and five quasiexperiments and one complex‐intervention development. More studies (n = 10) focused on targeting high‐risk groups (surveillance) than those at no higher risk (screening) (n = 8). Ten (45%) study interventions were theoretically underpinned. All of the study outcomes were self‐reported, behaviour related and nonclinical in nature. Meta‐analysis demonstrated the impact of the intervention on the degree of SSE activity from five studies, especially in the short term (up to 4 months) (odds ratio 2·31, 95% confidence interval 1·90–2·82), but with small effect sizes. Risk‐of‐bias assessment indicated that 61% of the studies (n = 11) were of weak quality. Conclusions: Four RCTs and a quasiexperimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer. However, the actual clinical impact remains unclear, and this is based on overall weak study (evidence) quality. What's already known about this topic? Few skin self‐examination (SSE) intervention development and evaluation studies have been identified to aid early detection of skin cancer, and no systematic reviews or meta‐analyses have been undertaken.SSE interventions employ varied delivery elements including technological, written and face‐to‐face material.Interventions focus on identifying melanoma and nonmelanoma skin cancer in the population and among high‐risk groups.Evaluative studies currently utilize only self‐reported outcome measures, including knowledge and self‐efficacy, in conducting SSE. What does this study add? Few SSE intervention evaluation studies have a low risk of bias.More studies employed interventions focused on surveillance, targeting those at higher risk, compared with screening SSE practices, for those at no increased risk of skin cancer.Interventions can effectively increase SSE behaviour, but few are underpinned by behaviour change theory.There is a need to promote structured SSE, but we require more theory‐based interventions and rigorously designed studies to evaluate their clinical impact. Linked Comment: Janda. Br J Dermatol 2019; 180:1285. Plain language summary available online [ABSTRACT FROM AUTHOR]

Many junior doctors have reported a lack of confidence in managing emergency conditions. However, there is insufficient literature summarising the current knowledge about the non-technical skills needed by junior doctors to tackle medical emergencies. This paper aims to identify the non-technical skills necessary for the management of medical emergencies by junior doctors. Three databases were systematically searched to identify relevant articles published between January 2000 and March 2020. In total, 8707 unique articles were identified and independently screened by at least two authors, using predetermined inclusion and exclusion criteria. A coding framework was applied to extract relevant data and for thematic analysis of the included studies. These methods have been performed following the PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. There were a total of 13 articles included in the thematic analysis. The result of this review was the identification of several key non-technical skills: teamwork, communication, asking for help, challenging seniority, task prioritisation, decision-making, leadership and handling stress. In conclusion, lack of non-technical skills in junior doctors has a negative impact on patient care in a medical emergency. The training of junior doctors can be re-evaluated and designed to reflect the importance of these non-technical skills. [ABSTRACT FROM AUTHOR]

Background This paper assesses variation in rates of emergency surgery (ES) amongst emergency admissions to hospital in patients with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia, and intestinal obstruction. Methods Records of emergency admissions between 1 April 2010 and 31 December 2019 for the five conditions were extracted from Hospital Episode Statistics for 136 acute National Health Service (NHS) trusts in England. Patients who had ES were identified using Office of Population Censuses and Surveys (OPCS) procedure codes, selected by consensus of a clinical panel. The differences in ES rates according to patient characteristics, and unexplained variations across NHS trusts were estimated by multilevel logistic regression, adjusting for year of emergency admission, age, sex, ethnicity, diagnostic subcategories, index of multiple deprivation, number of co-morbidities, and frailty. Results The cohort sizes ranged from 107 325 (hernia) to 268 253 (appendicitis) patients, and the proportion of patients who received ES from 11.0 per cent (diverticular disease) to 92.3 per cent (appendicitis). Older patients were generally less likely to receive ES, with adjusted odds ratios (ORs) of ES for those aged 75–79 versus those aged 45–49 years: 0.34 (appendicitis), 0.49 (cholelithiasis), 0.87 (hernia), and 0.91 (intestinal obstruction). Patients with diverticular disease aged 75–79 were more likely to receive ES than those aged 45–49 (OR 1.40). Variation in ES rates across NHS trusts remained after case mix adjustment and was greatest for cholelithiasis (trust median 18 per cent, 10th to 90th centile 7–35 per cent). Conclusion For patients presenting as emergency hospital admissions with common acute conditions, variation in ES rates between NHS trusts remained after adjustment for demographic and clinical characteristics. Age was strongly associated with the likelihood of ES receipt for some procedures. [ABSTRACT FROM AUTHOR]

Background Children's second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The 'First Steps 2 Smoke-free' (FS2SF) intervention is the first to trial this approach delivered as part of health professionals' routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women's capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others' smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage. [ABSTRACT FROM AUTHOR]

Background Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work. Objective This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users. Methods The evaluation used semi-structured interviews, focus groups and workshops (n  = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms. Findings HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research. Conclusion If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies. [ABSTRACT FROM AUTHOR]

Background Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work. Objective This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users. Methods The evaluation used semi-structured interviews, focus groups and workshops (n  = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms. Findings HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research. Conclusion If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies. [ABSTRACT FROM AUTHOR]

Background The NHS Five Year Forward View identifies a range of approaches for addressing the NHS's challenges. The Transition movement helps communities to reframe and rebuild their world by working on issues such as climate change, food, community relationships and localizing the economy. Methods This paper describes Transition using five short example projects and, informed by these, identifies mechanisms by which Transition could potentially help reduce pressure on the NHS. Results Transition is characterized by people self-organizing to address local challenges with benefits arising from both the outcomes and the process of the projects. Transition may be able to help the NHS reframe change, prevent disease, improve staff well-being and increase local economic resilience. Discussion The evidence base for the relationship between Transition and health is growing but is not yet well developed. This reflects the complexity of establishing an evidence base for wider determinants of health. There is substantial potential learning for those in the NHS about change outside formal institutional structures. Conclusions Transition provides new ways of thinking and acting to develop greater 'community intelligence', which could help the NHS in the face of increasing pressures. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Clinical commissioning groups (CCGs) were in early development when fieldwork took place. Public Health (PH) was moving into the local authority, and new ways of working were being established. Methods Three qualitative case studies in the North of England were undertaken using three different data collection methods: observations, interviews and the collection of documents that were related to the project. Comprehensive field notes were taken during observations, analysed alongside interview transcriptions and collected documentation using the software programme Atlas.ti. Results The relationship between the CCG and their local PH team was in development at the time of data collection. Three different PH roles could be discerned from the data: 'co-owner', 'service provider' and 'critical friend'. These roles impacted on the utilization of PH by CCGs and the wider relationship between the CCG and PH. Conclusions These models are 'ideal types', and in reality the CCG-PH relationship in most areas will contain elements of all three models. However, to think of them as set out in this paper is instructive for both CCGs and PH. It is important that CCGs and their PH colleagues to think clearly about what they are trying to achieve and how that can most effectively work together. [ABSTRACT FROM AUTHOR]

Background The evidence on public health interventions has traditionally focussed on a limited number of costs and benefits, adopted inconsistent methods and is not always relevant to the UK context. This paper develops a multi-criteria decision analysis (MCDA) approach to overcome these challenges. Methods A document review and stakeholder consultation was used to identify interventions and the criteria against which they should be assessed. The interventions were measured against these criteria using literature reviews and decision models. Criteria weights were generated using a discrete choice experiment. Results Fourteen interventions were included in the final ranking. Taxation was ranked as the highest priority. Mass-media campaigns and brief interventions ranked in the top half of interventions. School-based educational interventions, statins and interventions to address mental health problems ranked in the bottom half of interventions. Conclusions This paper demonstrates that it is possible to incorporate criteria other than cost-effectiveness in the prioritization of public health investment using an MCDA approach. There are numerous approaches available that adopt the MCDA framework. Further research is required to determine the most appropriate approach in different settings. [ABSTRACT FROM AUTHOR]

Recent policies concerning the enhancement of preventive medicine and health improvement have raised important questions about leadership in public health and have emphasized the roles that can be played by local authorities. In this light, it is worth exploring the activities undertaken by local authority Medical Officers of Health (MOsH), until their posts were abolished in 1974. The process leading to 1974 has often been blamed, at least partly, on the complacency, lack of imagination and demoralization of MOsH. However, when John Welshman asked the question 'watchdog or lapdog?' of the MOH, in a paper published in 1997, he concluded there was little justification for the latter label. This paper considers the career of Ian MacQueen, Aberdeen's last MOH, who is well known for the criticisms of his handling of the Aberdeen typhoid outbreak in 1964, which appeared in the report of an official enquiry. He was deemed to have made excessive use of the media and to have turned the outbreak into an event approaching a national crisis. However, in the context of MacQueen's 32 year career in Aberdeen, his use of the media during the typhoid outbreak was no aberration. Rather, it was characteristic of his determination to maintain an important role for the MOH within the NHS-era health services. There is therefore continuity between MacQueen's strategy and the ambitions of many MOsH before the NHS, who hoped for a unified health service with themselves occupying a leading role. MacQueen's actions during the typhoid outbreak also reflected his innovative activities in the field of health education, and his interest in the media for that purpose. In conclusion, MacQueen provides an example of an MOH who cannot be charged with complacency and resignation to a declining role: rather, his strategy of 'innovative traditionalism' sought to protect and extend his department's services. [ABSTRACT FROM AUTHOR]

Background Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. Methods A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. Results Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. Conclusions The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies. [ABSTRACT FROM AUTHOR]

Rangatahi Tū Rangatira (R2R) is a national health promotion programme in Aotearoa New Zealand which aims to promote cultural and physical wellbeing for rangatahi (young people) and their whānau (family). Grounded in tikanga Māori, the programme focuses on total wellbeing, leadership and cultural awareness providing rangatahi opportunities to increase their participation in physical activity and cultural knowledge through ngā taonga tākaro (Māori ancestral games). This paper focuses on an evaluation of this innovative health promotion programme focussing on the delivery of R2R by a local iwi provider in a rural area. Kanohi ki te kanohi (face-to-face) interviews and focus groups were used to collect data from a range of stakeholders including rangatahi, whānau, programme developers, and collaborating community organizations. A whānau ora (holistic) framework incorporating five core outcomes and key indicators specific to the programme was developed to assess the impact of delivery. Results demonstrated that rangatahi and their whānau were living healthier lifestyles through being more physically active; had gained an increased desire to succeed in their education and extra curriculum activities; and felt more connected to their community and te ao Māori. This demonstrates the importance of incorporating cultural elements to support improved lifestyle changes for rangatahi and their whānau and the connection between enhanced cultural identity and good health. [ABSTRACT FROM AUTHOR]

Serious Case Reviews (SCRs) for adults are commissioned to examine the ways in which local professionals and agencies worked together to safeguard a vulnerable adult or take place following harm or death of a vulnerable adult where there are concerns about agencies' actions or engagement. There is no national system in England for their collation or analysis. This paper presents the results of a study investigating SCRs for vulnerable adults where the person who was at risk of harm, harmed or died had a learning disability. Eighteen SCRs were identified and a further three where there are grounds for considering that the victim may have had such a disability. Three themes are presented: staff relationships; family and carers; and biography and chronology to draw out material relevant to social work policy and practice. At a time when the English government has announced plans for SCRs for adults to move to a statutory basis, this paper draws attention to their potential as learning materials, but also the risks of seeing them as presenting a full picture of practice. The case for local flexibility is argued. [ABSTRACT FROM AUTHOR]

The current agenda for change in the public sector challenges organisations to operate differently. Alongside managing severe cutbacks in investment, the UK social work sector faces a period of unprecedented change aimed at raising standards and improving practice whilst demonstrating value for money. Resulting in such a significant reform agenda and set within a climate of austerity, the UK government can be heard to call upon 'innovation' as the solution to achieving 'more for less' during such testing times. Whilst there is a body of literature examining the process of managing innovation, there remains an absence of knowledge relating to the tail end of the process concerned with moving from piloting to achieving sustainability. Drawing upon case examples of innovation in practice, this paper is unique in applying this literature to a social work setting. It sets out what is meant by innovation, what we know about diffusion and managing innovation, and presents a new framework that can be applied to assist with improving the process of replication in order to support sustainability. [ABSTRACT FROM AUTHOR]

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

With unprecedented numbers of people living longer and with higher expectations of how they will live out their last years, the management of end-of-life (EOL) services is being brought into sharper focus. Current models of EOL care have originated from the hospice and palliative care movement whose expertise, developed largely with cancer patients, is now being looked to for guidance in developing EOL practice for non-cancer dying patients. This paper challenges the social work profession to consider whether the hospice and palliative care model needs to be rethought; argues that social work is well positioned to help develop a more adequate model of care; and recommends a social model that builds upon the resources and networks already surrounding individuals. The social work profession is well placed to draw upon its values, culture and experience (particularly from the service user movement) and to get involved in developing new models of EOL care. This paper argues the benefits of community engagement through network mobilisation. [ABSTRACT FROM AUTHOR]

Background It has been suggested that to meet information needs of multiple stakeholders, evaluation of public health interventions should specify a broader range of outcomes, evaluate a wider range of interventions and use more varied methods, in particular for dealing with complexity. Current outcomes approaches in public policy are potentially fertile ground for addressing these challenges and embedding evaluation in processes for reporting on public health outcomes. This paper describes work by NHS Health Scotland to realize this potential. Methods Development of outcomes frameworks containing logic models which link actions to outcomes and specify outcome indicators for monitoring progress. Group processes to inform and help create shared ownership of models across key stakeholders. Creation of web-based resources to host outcomes frameworks with hyperlinks connecting logic models to evidence and outcome indicators. Results The outcomes frameworks have been used in various ways by policy-makers and practitioners to shape policy, planning and monitoring and evaluation. A range of additional challenges that need to be overcome in developing and using the outcomes frameworks has been identified. Conclusions Logic model-based outcomes frameworks are useful tools for supporting outcome-based planning and evaluation of public health interventions. [ABSTRACT FROM AUTHOR]

Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery. [ABSTRACT FROM AUTHOR]

Health services continue to be seen as significant settings for health improvement, and developments continue to be made in the nature of such work, means of optimal delivery and outcomes. This paper builds on previous work by reporting on activity in a series of sites within ‘NHS Health Scotland's (NHS HS)’ Health Promoting Health Service (HPHS) initiative. The objectives of the review were to: describe the achievements of HPHS sites, assess the degree of influence and embedding of the HPHS approach, review the support functions provided by ‘NHS HS' and identify the challenges to implementation and sustainability. The review identified a variety of activity associated with HPHS, ranging from a topic focused/behaviour change approach to efforts to re-orientate organizational features. The role that NHS HS played in developing settings capacity was largely endorsed, and there was, despite the existence of some barriers, evidence that HPHS was being successfully embedded within health service organizational policies and procedures. In particular, the role of a national level strategic guidance document to NHS CEOs [‘Chief Executive Letter (14)'] is noted as having been significant in creating a conducive context for HPHS. In this context, the paper concludes by reflecting more broadly on the current status of settings-based health improvement and suggests that on the basis of this review there should be optimism in pursuing a relatively expansive vision of health improvement in this particular setting and potentially others. [ABSTRACT FROM AUTHOR]

There are growing numbers of people using personalised support and it has been argued that this system of social welfare requires a very different workforce, with a re-evaluation of the role of social work. This paper reports empirical research that explores the perceptions of sixty-six disabled people, carers and elders of the role social workers should perform in a personalised world. The study used a grounded theory approach, obtaining data from a thread posted on eighteen internet forums. This novel methodology allowed access to ‘hard to reach’ groups and encouraged participation by individuals whose contributions may be inhibited by more traditional research methods. The analysis revealed that notions of power and autonomy were fundamental in understanding respondents' views of social work with concerns raised about the power of social workers and statutory organisations. These findings have implications for the recommendations made by the Social Work Task Force in 2009 for the reform of social work that argues for social work to have a greater professional status and potentially more power in the support relationship. [ABSTRACT FROM PUBLISHER]

The introduction of policies to transform adult social care, combined with scrutiny of social workers' roles and functions, has created considerable uncertainty about the future of social work with adults. This paper explores the implications of these policy changes, arguing that a number of dilemmas for practitioners—the balance between a preventative focus and tight budgets, autonomy and protection, safeguarding and capacity—will exist in the changed policy framework. In addition, it suggests that the various core functions of social work—assessment, advocacy and brokerage, safeguarding and capacity—also contain elements of conflict and incompatibility. As a result, the future of social work in this policy area runs a strong risk of becoming both fragmented and isolated. This could be reflected in the education requirements for social workers where, both historically and as a result of recent bitter experiences, the key priorities clearly relate to child protection rather than adult social care. To counter this, the paper suggests a number of core areas of practice that are common across social work, and that therefore continue to argue for the maintenance of a generic qualification. In addition, it specifies particular aspects of practice with adults that should continue to be highlighted. [ABSTRACT FROM PUBLISHER]

The health needs of displaced populations vary widely. The question as to the demands displaced populations place on health care resources and health care providers in their destination countries or regions remains the subject of great debate and contention. Internationally, health care workers are faced with complex challenges in providing care to displaced populations. This paper highlights some of the key health issues for displaced populations around the globe. Whilst ‘Band Aid’ solutions to existing health problems are useful in the short term, the paper describes the need for long-term public health prevention and educational strategies to enable displaced communities full access to and participation in their new ‘home’ communities. [ABSTRACT FROM AUTHOR]

Copyright of International Journal for Quality in Health Care is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The consequences of the move towards a primary-care-led NHS are shifts in activity from secondary care to primary care and more involvement of GPs in purchasing decisions. Although there are many anecdotal reports of an increasing primary care workload, there is little empirical evidence on the extent of such shifts. This paper reports the results of a survey of GPs in Grampian, in the north-east of Scotland, in which we attempted to gather information on the effects of shifts in the balance of care on general practice.Objective: We aimed to examine GPs perceptions of the extent to which general practice workload has changed due to planned and unplanned shifts in the balance of care.Methods: The design of the study was a self-reported questionnaire, which was administered in general practices in the Grampian Health Board, Scotland. The subjects were senior partners of all general practices and the main outcome measures were the types of changes which have taken place in general practice, their source, their effect on practice workload and how practices have reacted.Results: A 60% response rate was achieved (52/86); 85% (44/52) of GPs claimed that their workload had increased due to shifts in the balance of care and that 72% of the shifts were initiated outside the practice. Geriatric care, early discharge and psychiatric and psychology services, as well as nursing home care, were reported to have had the greatest impact on workload. The main aspects of practice workload which had increased included the number of GP consultations, general stress at work and number of home visits, whereas the net income of the practice and health outcome of patients were reported to have decreased. Practices have dealt with the increase in workload by shifting tasks from GPs to nurses and absorbing the workload into existing practices/patterns. Responders reported that ideally more nursing and GP staffing would be required. Overall, GPs welcomed the shifts in the balance of care, were more concerned about poor communication rather than actual increases in workload and claimed that morale had fallen.Conclusion: GPs perceive that the move towards a primary-care-led NHS is increasing the workload in general practice. If the shift in the balance of care away from secondary care is to be successful, then more information is required about such shifts to support practices as change continues. [ABSTRACT FROM AUTHOR]

Background: In 2005, the UK Department of Health recommended that a new role, the arrhythmia care coordinator (ACC), be created to guide patients through the diagnosis and treatment for arrhythmia. The belief was that this would improve the efficiency of care and improve their quality of life. The British Heart Foundation provided funding for 32 such posts, all of which were filled by arrhythmia specialist nurses, and commissioned an evaluation of the new service to assess its impact on patients. Aims: This paper focuses on the impact of the ACCs on their patients’ levels of anxiety and depression, hospital readmissions and costs to the National Health Service (NHS). Methods: From 2008 to 2010, using questionnaires, we conducted a longitudinal audit of the psychological status of the patients referred to the ACCs; we also assessed the ACCs’ impact on readmissions and cost benefits to the NHS using UK Hospital Episode Statistics. Results: We found high levels of anxiety and depression amongst patients. Nearly one-third were at the ‘borderline’ or ‘clinically anxious’ and 18% were at the ‘borderline’ or ‘clinically depressed’ level at their first assessment with small changes at follow-up. In arrhythmia specialist nurse sites, readmission rates were reduced by half. After deducting the cost of the ACCs and their support, the estimated annual saving was £29,357 per ACC. Conclusion: This evaluation has shown that the NHS saves £29,357 per year over and above the costs of employing a British Heart Foundation ACC and that all arrhythmia centres should be encouraged to employ an appropriate number of such specialists. [ABSTRACT FROM AUTHOR]

Despite an extensive evidence-base linking patterns of health with social determinants, recent public health policy has emphasized 'lifestyle diseases' and risk factor modification through behavioural and pharmacological intervention. In England, one manifestation of this has been the launch of the National Health Service Health Check programme. This paper reports findings from a small-scale qualitative study exploring experiences of engaging with a community-based health check in Knowsley, England, among 17 males and 19 females, with varying levels of risk for cardiovascular disease, who agreed to be contacted for the purpose of research at the time they underwent their check. Analysis revealed that the community-based nature of the checks provided opportunities for people to find out more about their health who might not otherwise have done so. Participants expressed a range of responses to the communication of the risk score, often revealing their confusion about its meaning. Changes in behaviour were identified, which participants connected with having had a check. This study raises questions about where, how and by whom health checks are delivered. Emphasis on health checks reflects the dominant individualist ideology, but this study also suggests that the process provides opportunities to enable and empower individuals, albeit in small ways. However, they remain a 'downstream' approach to public health, emphasizing medical and behavioural options for risk factor reduction rather than focussing on primary prevention through changes to the wider environment. Furthermore, although developed as a central feature of the UK's strategy to reduce health inequalities, health checks may widen them. [ABSTRACT FROM AUTHOR]

The rise of data science could be seen as a potental threat to the long-term status of the statistics discipline. I first argue that, although there is a threat, there is also a much greater opportunity to re-emphasize the universal relevance of statistical method to the interpretation of data, and I give a short historical outline of the increasingly important links between statistics and information technology. The core of the paper is a summary of several recent research projects, through which I hope to demonstrate that statistics makes an essential, but incomplete, contribution to the emerging field of 'electronic health' research. Finally, I offer personal thoughts on how statistics might best be organized in a research-led university, on what we should teach our students and on some issues broadly related to data science where the Royal Statistical Society can take a lead. [ABSTRACT FROM AUTHOR]

Background Molecular-driven oncology allows oncologists to identify treatments that match a cancer's genomic profile. Clinical trials are promoted as an effective modality to deliver a molecularly matched treatment. We explore the role of geographical accessibility in Italy, and its impact on patient access to clinical trials. Material and Methods We retrospectively reviewed molecular data from a single-institutional case series of patients receiving next-generation sequencing testing between March 2019 and July 2020. Actionable alterations were defined as the ones with at least one matched treatment on Clinicaltrials.gov at the time of genomic report signature. We then calculated the hypothetical distance to travel to reach the nearest assigned clinical trial. Results We identified 159 patients eligible for analysis. One hundred and one could be potentially assigned to a clinical trial in Italy, and the median distance that patients needed to travel to reach the closest location with a suitable clinical trial was 76 km (interquartile range = 127.46 km). Geographical distribution of clinical trials in Italy found to be heterogeneous, with Milan and Naples being the areas with a higher concentration. We then found that the probability of having a clinical trial close to a patient's hometown increased over time, according to registered studies between 2015 and 2020. Conclusions The median distance to be travelled to the nearest trial was generally acceptable for patients, and trials availability is increasing. Nevertheless, many areas are still lacking trials, so efforts are required to increase and homogenize the possibilities to be enrolled in clinical trials for Italian patients with cancer. [ABSTRACT FROM AUTHOR]

Background Adolescent mental health (AMH) needs in England have increased dramatically and needs exceed treatment availability. This study undertook a comparative assessment of the health and economic return on investment (ROI) of interventions to prevent and treat mental disorders among adolescents (10–19 years) and examined intervention affordability and readiness. Methods Interventions were identified following a review of published and grey literature. A Markov model followed a simulated adolescent cohort to estimate implementation costs and health, education, and economic benefits. Intervention affordability was assessed, comparing annual cost per adolescent with NHS England per capita spending, and an expert panel assessed intervention readiness using a validated framework. Results Over 10- and 80-year horizons, interventions to treat mild anxiety and mild depression were most cost-effective, with the highest individual lifetime ROI (GBP 5822 GBP 1 and GBP 257: GBP 1). Preventing anxiety and depression was most affordable and 'implementation ready' and offered the highest health and economic benefits. A priority package (anxiety and depression prevention; mild anxiety and mild depression treatment) would avert 5 million disability-adjusted life-years (DALYS) and achieve an ROI of GBP 15: GBP 1 over 10 years or 11.5 million DALYs (ROI of GBP 55: GBP 1) over 80 years. Conclusion The economic benefits from preventing and treating common adolescent mental disorders equivalent to 25% of NHS England's annual spending in 2021 over 10 years and 91% over 80 years. Preventing and early treatment for anxiety and depression had the highest ROIs and strong implementation readiness. [ABSTRACT FROM AUTHOR]

Background: concern over the sustainability of the National Health Service (NHS) is often focussed on rising numbers of hospital admissions, particularly among older people. Hospital admissions are enumerated routinely by the Hospital Episode Statistics (HES) Service, but published data do not allow individual-level service use to be explored. This study linked information on Hertfordshire Cohort Study (HCS) participants with HES inpatient data, with the objective of describing patterns and predictors of admissions among individuals.Methods: 2,997 community-dwelling men and women aged 59–73 years completed a baseline HCS assessment between 1998 and 2004; HES and mortality data to 31 March 2010 were linked with the HCS database. This paper describes patterns of hospital use among the cohort at both the admission and individual person level.Results: the cohort experienced 8,741 admissions; rates were 391 per 1,000 person-years among men (95% CI: 380, 402) and 327 among women (95% CI: 316, 338), P < 0.0001 for gender difference. A total of 1,187 men (75%) and 981 women (69%) were admitted to hospital at least once; among these, median numbers of admissions were 3 in men (inter-quartile range, (IQR): 1, 6) and 2 in women (IQR: 1, 5). Forty-eight percent of those ever admitted had experienced an emergency admission and 70% had been admitted overnight.Discussion: It is possible to link routinely collected HES data with detailed information from a cohort study. Hospital admission is common among community-dwelling ‘young-old’ men and women. These linked datasets will facilitate research into lifecourse determinants of hospital admission and inform strategies to manage demand on the NHS. [ABSTRACT FROM AUTHOR]

Quality improvement programs often pose unique project management challenges, including multi-faceted interventions that evolve over time and teams with few resources for data collection. Thus, it is difficult to report methods and results. We developed a program to reduce central line-associated bloodstream infections (CLABSIs) and improve safety culture in intensive care units (ICUs). As previously reported, we worked with 103 Michigan ICUs to implement this program, and they achieved a 66% reduction in the median CLABSI rate and sustained the reduction. This success prompted the spread of this program to Spain, England, Peru and across the USA. We developed a logical framework approach (LFA) to guide project management; to incorporate the cultural, clinical and capacity variations among countries; and to ensure early alignment of the project's design and evaluation. In this paper, we describe the use of the LFA to systematically design, implement and evaluate large-scale, multi-faceted, quality improvement programs. [ABSTRACT FROM PUBLISHER]

Summary. Unusual clusters of disease must be detected rapidly for effective public health interventions to be introduced. Over the past decade there has been a surge in interest in statistical methods for the early detection of infectious disease outbreaks. This growth in interest has given rise to much new methodological work, ranging across the spectrum of statistical methods. The paper presents a comprehensive review of the statistical approaches that have been proposed. Applications to both laboratory and syndromic surveillance data are provided to illustrate the various methods. [ABSTRACT FROM AUTHOR]

The post-devolution settlement in 1999 created the environment for major national policy and legislative reform across all dimensions of Scottish life. This paper seeks to understand better the place of child and family-oriented social work in post-devolution Scotland. Scottish social work policy in general and children's services policy in particular are analysed to consider where policy makers appear to locate social work resources. An alternative reading of these post-devolution policies suggests that a policy ‘effect’ is being produced that appears to lock social work out of early intervention and prevention. Ambiguities and hidden elements reveal an identity for social work in policy that primarily aligns it with control functions where balancing care and control and the use of involuntary measures is to the fore—the ‘hard cases’. This analysis points to the importance of social work taking a critical distance to policy formation and what it may mean for its identity and contribution to meeting the needs of the most vulnerable children growing up in Scotland today. [ABSTRACT FROM PUBLISHER]

A brief overview of the Green Paper on the National Health Insurance (NHI) policy of South Africa is presented. It describes the intention of the NHI to ensure equity, address the inequalities presented by the current private and public health system and present an ambitious plan to change the face of the South African health care system over the next fourteen years. It provides the context of the currents system that provides the case for the change. It also provides some detail on the structure of the proposed new Re-engineered Primary Health Care system as well as the future financing of this bold new health care system for South Africa. The challenge will be in its implementation. [ABSTRACT FROM AUTHOR]

The literature on the use of performance measurement in government has focused much attention on hypothesized unintended dysfunctional consequences that such measurement may produce. We conceptualize these dysfunctional consequences as involving either effort substitution (reducing effort on nonmeasured performance dimensions) or gaming (making performance on the measured performance dimension appear better, when in fact it is not). In this paper, we examine both performance impacts and dysfunctional consequences of the establishment in the English National Health Service of a performance target that no patient presenting in a hospital accident and emergency department (emergency room) wait more than 4 hours for treatment. Using data from all 155 hospital trusts in England, we find dramatic wait-time performance improvements between 2003 and 2006 and no evidence for any of the dysfunctional effects that have been hypothesized in connection with this target. We conclude by discussing when one would expect dysfunctional effects to appear and when not. [ABSTRACT FROM PUBLISHER]

However, it is not necessarily correct that the population should have been representative of those at greatest risk of developing an aneurysm, as usual National Institute for Health and Care Excellence methodology requires that preferences for health and health care are derived from a general population sample, rather than a sample specific to the condition under consideration[1]. Systematic review and qualitative evidence synthesis of patient-reported outcome measures for abdominal aortic aneurysm. [Extracted from the article]

The importance of public policy as a determinant of health is routinely acknowledged, but there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin public policy influence people's health. This paper explores the possible reasons behind the absence of a politics of health and demonstrates how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategy and policy, and to more realistic and evidence-based public health and health promotion practice. [ABSTRACT FROM AUTHOR]

Background Global population aging, and the accelerated increase in the number of oldest-old adults, over 80 years, has implied a heightened need for long-term care (LTC). We aimed to provide a theoretical care cascade of LTC services to assess publicly funded LTC (Analysis 1) and to investigate the association between the use of LTC insurance (LTCI) and unmet care needs among older people (Analysis 2) in South Korea. Methods Analysis 1 used data from the eighth wave (2020) of the Korean Longitudinal Study of Aging (KLoSA), the 2020 National Health Insurance Service LTCI Statistical YearBook and the 2020 National Awareness Survey of LTCI. The care cascade consisted of the target population, service contacts, coverage and outcomes. Analysis 2 used the fifth to eighth waves of KLoSA, and LTCI analysis was based on three groups: not aware, aware but do not use and aware and use. Unmet care needs were defined as the absence of help among older people with care needs. Results Among 8,489,208 people aged 65 or older in 2020, 1,368,148 (16.1%) were estimated to want care. Of these, 62.7% (N  = 857,984) had LTCI service contact and 807,067 (94.1%) of those had used LTCI services in the past year (Analysis 1). Older people who were aware and used LTCI were less likely to report unmet activities of daily living (ADL) (prevalence ratio (PR): 0.34, 95% confidence interval (CI): 0.18–0.66) or unmet instrumental ADL (IADL) needs (PR: 0.27, 95% CI: 0.17–0.43) than those who were not aware (Analysis 2). Conclusions This article provides a theoretical cascade to assess LTC provision in South Korea and a preliminary model for other countries. Korea's LTCI is associated with reduced unmet ADL and IADL needs. [ABSTRACT FROM AUTHOR]

Background Flooding can cause long-term, significant impacts on mental health in affected populations. We explored help-seeking behaviour of households affected by flooding. Methods A cross-sectional analysis was conducted on National Study of Flooding and Health data on households flooded in England in winter 2013/14. Participants (Year 1: n  = 2006; Year 2: n  = 988; Year 3: n  = 819) were asked if they sought help from health services and other sources. Logistic regression was conducted to calculate odds ratios (ORs) of help-seeking in flooded and disrupted participants compared to unaffected, adjusted for a priori confounders. Results The odds of seeking help from any source 1 year after flooding were greater for flooded participants [adjusted OR (aOR): 1.71, 95% confidence interval (CI): 1.19–1.45] and those disrupted by flooding (aOR: 1.92, 95% CI: 1.37–2.68) compared to unaffected participants. This continued in the second year (flooded: aOR 6.24, 95% CI: 3.18–13.34; disrupted: aOR: 2.22, 95% CI: 1.14–4.68), and help-seeking remained greater in flooded than unaffected participants in the third year. Flooded and disrupted participants were particularly likely to seek help from informal sources. Help-seeking was more prevalent amongst participants with mental health outcomes, but a notable proportion of individuals with any mental health outcome did not seek help (Year 1: 15.0%; Year 2: 33.3%; Year 3: 40.3%). Conclusions Flooding is associated with increased demand for formal and informal support, persisting for at least 3 years, and an unmet need for help amongst affected individuals. Our findings should be considered in flood response planning to reduce the long-term adverse health impacts of flooding. [ABSTRACT FROM AUTHOR]

Thomas Legge achieved much in his professional lifetime. The purpose of this lecture is to highlight some of these achievements in the light of what we have achieved since then. In other words, if Legge was in the audience today, how would he feel we have performed?On industrial maladies, progress has been made in reducing poisoning by heavy metals but our success with chrome ulceration and lead depends on surveillance and control. Room for improvements remain. For asbestos related diseases, Legge would be disappointed with our progress. Two areas of particular concern to Legge were upper limb disorders and occupational neurosis. Much remains to be done.As a member of the 1st Committee on Compensatable Diseases, a review of the Scheme to date will focus on the common diseases now being prescribed and on the threats to the Scheme from the Benefits review.For the future, there are many challenges in the newer workplaces and the changing workforces. The HSE initiatives for a new occupational strategy and the Government Green Paper on Public Health provide great opportunities for the occupational health professional to influence the nature and shape of future public health strategy.Above all we must have some of Legges characteristics to achieve this-vision, passion and commitment. [ABSTRACT FROM PUBLISHER]

Objectives The main purpose of the study has been to examine changes in Internet use among men and women in 3 age groups (midlife, early old age, and advanced old age) between 2014 and 2021. We tested 2 hypotheses: The complementary hypothesis posits that online activities reproduce gender differences in offline activities. The compensatory hypothesis posits that women are catching up over time in male-typed activities as Internet access approaches saturation for both genders. Methods We used representative, longitudinal data from the German Ageing Survey collected in 2014, 2017, 2020, and 2021 (n = 21,505, age range 46–90 years). We ran logistic regressions on Internet access and Internet use for 4 different gender-typed activities: social contact (female-typed), shopping (gender-neutral), entertainment (male-typed), and banking (male-typed). Results Between 2014 and 2021, women drew level with men in Internet access. Gender differences in all 4 forms of Internet use declined considerably between 2014 and 2021. Women overtook men in using the Internet for social contact. In older age groups, men held the lead regarding online banking. During the coronavirus disease 2019 (COVID-19) crisis, women caught up to men in Internet use, especially for entertainment. Discussion Overall time trends support the complementary hypothesis. By contrast, the finding that women have been catching up in some male-typed online activities during the COVID-19 pandemic supports the compensatory hypothesis. [ABSTRACT FROM AUTHOR]

Background The consequences of financial crises on patients' use of healthcare have been widely discussed. This paper seeks to ascertain whether the position of key players, i.e. doctors, may reveal realities other than those officially reported about the 2008 financial crisis. Methods In 2013-14, a national survey of doctors was conducted in Portugal, which received international assistance in the wake of the financial crisis. An exploratory model comprising descriptive statistics, regression and independence analyses focused on doctors' experience of patients' use of medications, consultations, exams and treatment services, and whether they stopped treatments. Results According to doctors, an unspecified number of patients experienced difficulties using healthcare as more patients requested prescriptions for cheaper medications or simply stopped treatments. Significant variations were found according to speciality, years of practice and sector of activity. Conclusions Cost-containment mechanisms are regarded as necessary. However, the evidence indicated a side effect, i.e. a decrease in patients' ability to use healthcare, including in the National Health Service (NHS). It also highlighted the need to listen to health professionals as key informants on patient's behaviour and the daily functioning of health services. [ABSTRACT FROM AUTHOR]

Background The Health Trainers Service is one of the few public health policies where a bespoke database--the Data Collection and Reporting System (DCRS)--was developed to monitor performance. We seek to understand the context within which local services and : DCRS and to consider how this might influence interpretation of collected data. Methods In-depth case studies of six local services purposively sampled to represent the range of service provider arrangements, detailed interviews with key stakeholders (n = 118). Results Capturing detailed information on activity with clients was alien to many health trainers' work practices. This related to technical challenges, but it also ran counter to beliefs as to how a 'lay' service would operate. Interviewees noted the inadequacy of the dataset to capture all client impacts; that is, it did not enable them to input information about issues a client living in a deprived neighbourhood might experience and seek help to address. Conclusions The utility of the DCRS may be compromised both by incomplete ascertainment of activity and by incorrect data inputted by some Health Trainers. The DCRS is also underestimate the effectiveness of work health trainers have undertaken to address 'upstream' factors affecting client health. [ABSTRACT FROM AUTHOR]

This article reports findings from a study on the effect of the adjustments or 'easements' that were made to the 2014 Care Act when measures to manage the impact of COVID-19 were introduced in England in 2020. Only eight local authorities (LAs) implemented the changes permitted. The experiences of five are explored in this article. Data were collected in 2021 through interviews with Directors of Adult Social Services and other senior managers in these LAs and analysed using a thematic approach. Participants referred to the challenges under which they were working pre-pandemic, including resource pressures and problems recruiting and retaining staff. Despite the conditions attached to adopting easements these LAs had done so because of the uncertainties they were facing. All ceased to use them within a short time because they could manage without them. They had been shocked by the concerted opposition to easements and the time necessitated in responding to this. They contrasted their experiences with the apparent ease with which NHS colleagues had been able to change their practices. The experiences of these LAs may contribute to planning for the continuity of social care in any future emergency. [ABSTRACT FROM AUTHOR]