Search

The UK's National Health Service (NHS) COVID-19 contact tracing app was announced to the British public on 12th April 2020. The UK government endorsed the app as a public health intervention that would improve public health, protect the NHS and 'save lives'. On 5th May 2020 the technology was released for trial on the Isle of Wight. However, the trial was halted in June 2020, reportedly due to technological issues. The app was later remodelled and launched to the public in September 2020. The rapid development, trial and discontinuation of the app over a short period of a few months meant that the mobilisation and effect of the discourses associated with the app could be traced relatively easily. In this paper we aimed to explore how these discourses were constructed in the media, and their effect on actors – in particular, those who developed and those who trialled the app. Promissory discourses were prevalent, the trajectory of which aligned with theories developed in the sociology of expectations. We describe this trajectory, and then interpret its implications in terms of infectious disease public health practices and responsibilities. [ABSTRACT FROM AUTHOR]

This paper examines the development of electronic health records within the National Health Service (NHS) by an analysis of a series of pilot projects funded by the Electronic Record Development and Implementation Project (ERDIP), one aspect of the work of the NHS Information Authority (NHSIA) (As of 1 April 2005, the NHSIA ceased to operate. Much of its work is continued by Connecting for Health and the Health and Social Care Information Centre.) The focus of the analysis is on the extent to which identifying and correcting error within health records was explored through these projects. The inherent potential for error and resultant impact on patient safety is highlighted, by considering the context of the record, the content of the record and the process of change from paper-based or piecemeal electronic health records to integrated electronic health records. While the process of change highlights issues of data security and access, it is the variability in starting points for different organizations that possibly poses most risk to patient safety. Issues relating to the content of the record can to some extent be minimized by the effective use of technology, but the tension between coding and qualitative data requires further consideration in terms of its impact on patient safety. This paper concludes that the development of electronic health records has to be viewed within the context of governance and patient safety, and the implications articulated. [ABSTRACT FROM AUTHOR]

This paper discusses the need for wider reform of UK chemicals policy following exit of the UK from the EU, focusing on chemical flame retardants as an example. Exposure to these chemicals presents a range of human environmental health issues and reveals important limitations in the UK's approach to reconciling fire safety with environmental and public health protections. Key strategic issues that would advance evidence-informed policy in this area are identified. [ABSTRACT FROM AUTHOR]

Commentators have argued that we have entered a new era of migration described by Vertovec as a ‘transformative diversification of diversity’. Multiple variables of difference in the ethnicity, immigration status, rights and entitlements, age and gender profiles and patterns of distribution, of new migrants mean that the UK, and many other EU countries, are now home to the most diverse population ever experienced. The onset of super-diversity challenges traditional multicultural models of welfare provision originally based upon an understanding of migrants as large and geographically contained clusters of predominantly postcolonial migrants. These changes are occurring at a time when migration has become highly politicized, multiculturalism is being questioned, a shift is under way towards assimilation and welfare provision has become re-racialized. This paper argues that models of welfare provision need to be rethought to take into account the new reality of super-diversity in a way that is affordable, politically acceptable and meets the needs of all. Using data from research undertaken from studies of health service provision in the West Midlands the paper explores the challenges of meeting the needs of new migrants under existing provision, the costs of failing to adapt to super-diversity and the reasons why provision has failed to adapt. The paper concludes by arguing the need for different approaches to provision, and suggesting some new ways forward. [ABSTRACT FROM PUBLISHER]

Psychological therapy today plays a key role in UK public mental health. In large part, this has been through the development of the (specifically English) Improving Access to Psychological Therapies (IAPT) programme. Through IAPT, millions of citizens have encountered interventions such as cognitive behaviour therapy, largely for the treatment of depression and anxiety. This article interrogates how this national response to problems of mental ill-health – and the problematization itself – was developed, accounted for, and sustained. By imbricating economic expertise with accounts of mental ill-health and mechanisms of treatment, IAPT has revivified psychological framings of pathology and therapy. However, it has done so in ways that are more familiar within biomedical contexts (e.g. through recourse to randomized controlled trial studies). Today, the initiative is a principal player in relation to which other services are increasingly developed. Indeed, in many respects IAPT has transformed from content to context within UK public mental health (in a process of what I term 'contextification'). By documenting these developments, this paper contributes to re-centring questions about the place and role of psychology in contemporary healthcare. Doing so helps to complicate assumptions about the dominance of linear forms of (de)biomedicalization in health-systems. [ABSTRACT FROM AUTHOR]

There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they could arise from differences in patients' beliefs, knowledge, costs, resources and capabilities. On the supply side, professional beliefs and attitudes, and risk selection or cream-skimming by providers may result in inequities. This paper discusses whether these factors are at play within the English NHS and analyses whether current policy to extend patient choice of provider is likely to reduce or increase these inequities. It shows that extending patient choice may leave unchanged inequity due to differences in health beliefs (because choice does not affect these directly), increase inequity due to unequal resources (because patients may have to travel further), and decrease inequity due to unequal capabilities (because the poor will have access to a new and, for them a more effective, source of leverage over health service professionals). On the supply side, there will be little change. The paper then discusses policy options for dealing with factors that contribute to greater inequity on the demand side. It proposes a package of supported choice whereby individuals from lower SEGs would receive assistance in making choices, including an identified key worker to act as patient care adviser and help with transport costs. The paper concludes that policies for extending patient choice can enhance equity – so long as they are properly designed. [ABSTRACT FROM AUTHOR]

This paper describes an ethnographic study of the care pathway community. Qualitative data generated through attendance at the annual care pathways conference and a regional group network are assembled in order to present an interpretation of the spread of pathways across the health-care field and identify the stakeholders involved, as well as their interests, aspirations and alignments. The growing popularity of care pathway methodology can be explained by its effectiveness in reconciling clinical and management interests in offering a single solution to shared health service problems. However, this breadth of appeal disguises tensions between clinical and management agenda which creates challenges in inscribing this multiplicity of interests into the pathway design. This helps to explain the challenges of pathway development and the range of interventions to which the term 'pathway' is applied. In a second, companion paper, I consider how the community has responded to these concerns and draw on social sciences concepts to offer an alternative approach. [ABSTRACT FROM AUTHOR]

Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into 'mainstream' clinical provision in the National Health Service. Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized. [ABSTRACT FROM AUTHOR]

The article is a critical review of the community care movement in Great Britain and the U.S. and its implications for social work practice. Parallel to the developments in Great Britain, the communities care movement in the U.S. developed quickly after the Second World War and flourished in the 1970s. The National Mental Health Act of 1946 was passed in 1947. This act created the National Institute of Mental Health to provide research and training grants to develop community-based psychiatric services as well as close down mental-health hospitals. In the 1980s, the practice of community care was under critical review by professionals and policy-makers in Great Britain. In 1986, two important papers, "Making a Reality of Community Care" and "Community Care: An Agenda for Action," were published by the government. In these two reports, the gloomy picture of community care for the mentally ill and other disabled groups was critically reviewed. Similarly, in the U.S., the practice of community care was under criticism. In 1984-5, a Delphi process study found that 42 states had no consensus on the support of chronic mental patients being treated outside institutions.

The article discusses the relevance of diagnosis in general practice to implications for quality of care in Great Britain. It examines studies that concentrate on respiratory and non-respiratory illnesses which reveal the factors that affect the making of diagnostic and management decisions in general practice. It notes the policies enacted to improve public health in the area which include a strong focus on the long-term health needs of patients.

Situation Reports (SitReps) is an internal Department of Health performance data collecting system. Although intended primarily for internal use, the data are also used to answer parliamentary questions, brief ministers and to inform national performance indicators. This paper reviews the data collection system and data-set, and shows how it can be used to evaluate delays in hospital discharge under the Community Care (Delayed Discharges etc.) Act 2003. However, limitations in the data include the fact that the data have only recently been extended to National Health Service (NHS) non-acute settings and do not include NHS patients in the private acute sector. Further, as the data-set derives from a weekly aggregate return rather than from individualized person-based records, it cannot be used to evaluate length of delay, or to link to other relevant data such as emergency readmissions. The provision of individualized data to facilitate linkage and extending coverage would increase its potential future use. Categories of delay should be further refined to facilitate monitoring of delays due to disputes about eligibility. [ABSTRACT FROM AUTHOR]

Despite the criticality of nurse rostering practices, there is a surprising lack of attention paid to this managerial activity both in practice and in the health-service management literature. This paper reports the results of an inductive, empirical study of rostering practices in the UK National Health Service with a view to developing a shared understanding of roster planning processes and of what constitutes rostering effectiveness. A survey of rostering practices in 50 wards, followed by five in-depth, longitudinal case studies, revealed the complexity of rostering activities, and identified the main design parameters, which were used to specify rostering systems and to prepare periodic rosters. Rostering activities were perceived to directly impact upon service delivery, resource utilization and nurse retention. A number of poor rostering practices were identified, which could lead to dysfunctional behaviour. This analysis points to a clear managerial imperative to improve local competencies in roster planning and control, recognizing their strategic significance in contributing to hospital effectiveness. A 'Strategic Roster Planning and Control (SRPC)' model is proposed, which may provide a framework for evaluating rostering effectiveness, and a platform for the sharing of best practice, in order to stimulate organizational learning and achieve nationwide improvements in hospital performance. [ABSTRACT FROM AUTHOR]

Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere. [ABSTRACT FROM AUTHOR]

Introduction: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups. Methods: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions. Results: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses. Conclusion: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine. [ABSTRACT FROM AUTHOR]

The paper reports the results of a study on benchmarking activities undertaken by the procurement organization within the National Health Service (NHS) in Scotland, namely National Procurement (previously Scottish Healthcare Supplies Contracts Branch). NHS performance is of course politically important, and benchmarking is increasingly seen as a means to improve performance, so the study was carried out to determine if the current benchmarking approaches could be enhanced. A review of the benchmarking activities used by the private sector, local government and NHS organizations was carried out to establish a framework of the motivations, benefits, problems and costs associated with benchmarking. This framework was used to carry out the research through case studies and a questionnaire survey of NHS procurement organizations both in Scotland and other parts of the UK. Nine of the 16 Scottish Health Boards surveyed reported carrying out benchmarking during the last three years. The findings of the research were that there were similarities in approaches between local government and NHS Scotland Health, but differences between NHS Scotland and other UK NHS procurement organizations. Benefits were seen as significant and it was recommended that National Procurement should pursue the formation of a benchmarking group with members drawn from NHS Scotland and external benchmarking bodies to establish measures to be used in benchmarking across the whole of NHS Scotland. [ABSTRACT FROM AUTHOR]

The recent acute budgetary pressures within the English National Health Service (NHS) have accentuated calls for targeted disinvestment thereby eliminating ineffective or low-value services to provide resources that can be reallocated toward more cost-effective purposes. This challenge extends beyond allocating new resources wisely, a goal that has been, since its inception, the primary focus of the National Institute for Health and Clinical Excellence (NICE). But on 6 September 2006, the Department of Health announced a new mandate for NICE to help the NHS identify interventions that are not effective. This paper discusses current NICE efforts to support value in the NHS and then explores the policy options available to the Institute as it prepares to launch a programme to meet the NHS request for guidance on disinvestment. All of the possible options present challenges. NICE will need to collaborate in new ways with partners inside, and perhaps outside, the NHS. However, the Institute has an established reputation for rigour, transparency and political durability that makes it well qualified to sustain public support in the face of difficult decisions. Disinvestment will provide a stern test of these qualities. [ABSTRACT FROM AUTHOR]

The UK National Health Service (NHS) is facing recruitment challenges that mean it will need to become an 'employer of choice' if it is to continue to attract high-quality employees. This paper reports the findings from a study focusing on allied health professional staff (n = 67), aimed at establishing the expectations of the NHS inherent in their current psychological contract and to consider whether the government's drive to make the NHS a model employer meets those expectations. The findings show that the most important aspects of the psychological contract were relational and based on the investment made in the employment relationship by both parties. The employment relationship was one of high involvement but also one where transactional contract items, such as pay, were still of some importance. Although the degree of employee satisfaction with the relational content of the psychological contract was relatively positive, there was, nevertheless, a mismatch between levels of importance placed on such aspects of the contract and levels of satisfaction, with employees increasingly placing greater emphasis on those items the NHS is having the greatest difficulty providing. Despite this apparent disparity between employee expectation and the fulfilment of those expectations, the overall health of the psychological contract was still high. [ABSTRACT FROM AUTHOR]

Following its review of the Sexual Offences Act (2003), the Home Office undertook a review of legislation on sex work. Policy will be shaped by responses to the consultation document, Paying the Price: a Consultation Paper on Prostitution. How the consultation conceives problems of sex work is therefore crucially important. Sex work service providers and rights campaigners are concerned that the consultation turns attention away from health issues and focuses instead on legislation to penalize both sex workers and their clients. Further, Paying the Price seeks solutions for sex work at the individual rather than structural level. Sex workers might be recommended to 'exiting programmes' and individual pimps and traffickers prosecuted, but there is no attempt to prevent sex worker abuse through human rights and employment laws. This article identifies the problems associated with a perspective that prioritizes punitive responses over public health strategies on sex work. [ABSTRACT FROM AUTHOR]

Explicit priority setting in healthcare, which often involves multiple criteria and value judgements, has come to prominence in a number of different healthcare systems over the past decade. Drawing on the results of a survey of priority setting in practice in the UK National Health Service, this paper analyses issues associated with quantification in priority setting, focusing on techniques for eliciting and aggregating values, the criteria and form of models used and their application in priority setting. The findings reveal a clear focus on equity, a strong concern to demonstrate openness, consistency and transparency in priority setting—leading to greater use of explicit multi-criteria models—and a notable focus on the quality of 'evidence'. However, reported difficulties in weighting over-long lists of non-commensurate and overlapping criteria, the inclusion of inappropriate criteria, and attributes of the form of models employed, lead to the conclusion that the implications of the methods are not always appreciated, the resulting priority 'scores' sometimes misunderstood and, in some cases, the concern for transparency and explicitness appears to outweigh concern for methodological understanding—leading to an illusion of transparency. [ABSTRACT FROM AUTHOR]

Objectives: All health care providers in England are required to conduct surveys of their patients' experience of health care. Data from such surveys contribute to the 'star rating' performance indicators. However, there are concerns that these subjective measures may be influenced more by characteristics of patients than by true variations in the quality of care. The purpose of this paper is threefold: to determine the relationship between demographic characteristics and an index measure of patients' reported experience; to explore the extent to which patients' experiences may be accounted for by the particular National Health Service (NHS) trust they attended; and to assess how meaningful a summary index is in terms of its ability to discriminate between providers. Methods: Data from patients in the National Survey of National Health Service Patients treated for coronary heart disease in 194 NHS trusts. Patients were sent questionnaires after discharge, with a covering letter and a prepaid stamped addressed envelope. Up to two reminders were sent to non-responders. Multi-level linear regression models were used to estimate the extent to which patients' experiences differed between trusts and the association of demographic variables with the summary index. Results: In total, 116 872 patients were sent questionnaires, but 3399 proved to be ineligible for the survey. Responses were gained from 84 310 (74.3% of eligible respondents). Age and sex were most strongly associated with reported patients' experiences. However, the actual impact of age and sex on patients' experience is small, accounting for less than 3% of the variance. The proportion of the variance that was accounted for by the hospital trust in which patients were treated was only 5%. Conclusions: Demographic characteristics do not appear to account for differences between hospital trusts in patients' experience of health care. However, there is considerable variation in patients' experience within each provider. This would suggest that summary indices of patients' experience should not be used to rank providers, although detailed information from patient surveys have a useful role in determining priorities for quality improvement within individual hospitals and for assessing changes over time. [ABSTRACT FROM AUTHOR]

The NHS Plan envisages a paradigm shift from a centralized, producer-led National Health Service (NHS) to a devolved, patient-centred health care service, fuelled by a substantial investment in human resources, beds, hospitals and infrastructure. The planned net increase of 20 000 nurses by 2004 is examined in the light of findings from a qualitative study of nurse satisfaction, commitment or intention to leave their hospital, nursing or the NHS, involving 124 nurses in four London hospitals. This paper presents nurses' perceptions and rankings of retention strategies and we compare these with the Plan's proposals. Lastly we propose an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention and quality of patient care, based on a conceptual framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain, which highlights the scope of the challenges confronting the Plan, in both design and implementation of proposals designed to improve working conditions as a foundation for nurse recruitment and retention. Our principal findings are that just 57% of our interviewees may be viewed as 'core loyals' to the profession, 12% are serious in their intention to leave and the remainder may be sensitive to further deterioration in working conditions or a failure to meet expectations on pay. Such findings if realized clearly threaten the Plan's success. [ABSTRACT FROM AUTHOR]

This paper examines some fundamental issues pertaining to the use of, as well as to the distinctive characteristics of, information technology in relation to the development of information systems within the UK National Health Service (NHS). The paper refers to the current Resource Management initiative in the NHS, which involves the fabrication of information systems to connect medical activity to resource usage, and thus to costs. Examining the features of some of the rival inscriptions undergoing development of make this connection visible, the paper highlights the properties of information technology in enhancing their mobilization. It also addresses the immutability and combinability of these inscriptions, and discusses some of the implications, in terms of medical practice and knowledge, which may follow from their use. [ABSTRACT FROM AUTHOR]

In this study, we explore how participants articulate experiences of emotions during Covid-19 lockdown in the UK. We posit that emotions fulfil experiential and interpersonal functions, which are construed and conveyed through language choices. An online narrative survey was carried out. About 88 responses were analysed. Participants were from England and Wales. The mean age was 48.9 years old (SD = 62). A mixed-method approach was used. This combined quantitative Corpus Linguistics analysis and qualitative Interpretative Phenomenological Analysis with linguistic analysis. The findings show similarities to the public health and medical literature that highlight negative emotions, such as fear, distrust and anger in participants. However, we also found positive emotions not considered elsewhere, including happiness, relaxation, safety, optimism for the future and connectedness arising from the thematic IPA analysis. Emotions were construed using language explicitly labelling emotions and language implicitly signalling emotions. Our study highlights implications for managing risk behaviours associated with transmission in public health practices such as social distancing, as indicated by negative emotions. We also bring to light implications with perceived benefits of engaging in protective behaviours and social support central to public health measures, as suggested by the communication of positive emotions. [ABSTRACT FROM AUTHOR]

This paper contrasts the views of two prominent politicians on the ways in which the distribution of hospital services should be organised, and relates them to the views of Hayek on the nature of planning. It is argued that, in relying on an independent regulator to supervise access to health care under the new 'foundation' hospitals regime in the English National Health Service (NHS), not only is the Labour government distancing itself clearly from old-style top-down planning, it also risks greater variability in the definition of fair access to health care. There are relevant historical parallels with the mixed economy of the pre-NHS era that policy-makers should make explicit. [ABSTRACT FROM AUTHOR]

The British National Health Service and other publicly funded health systems operate on the principle that health care should be provided solely on the basis of need. Yet the literature abounds with reports of bias in health care use. In order to defend such a charge, two conditions must be met. The first condition is that treatment decisions must be shown to be unfair in that they are not made solely on the basis of need. This paper demonstrates the importance of considering the fair distribution of health care from two, related, perspectives. The first is that people with equal needs should be treated the same (equal use for equal need). This is referred to as the achievement of horizontal equity. The alternative perspective is that people with greater needs should have more treatment than those with lesser needs (unequal use for unequal need). This is referred to as the achievement of vertical equity. Although these perspectives are logically linked, demonstration of equal use for equal need does not necessarily indicate unequal use for unequal need. This is because it cannot be assumed that equal use occurs at every level of need. The second condition that must be met is that clinical judgement must be shown to be influenced by prejudicial notions about patients. Such research is fraught with methodological difficulties, and the charge of biased clinical decision-making is usually made as a result of a process of exclusion. Methods that could be used to examine the extent to which inequalities in health care use are due to bias are described. [ABSTRACT FROM AUTHOR]

This section offers medical practice-related news briefs. A study by T. A. Holt reveals a public health concern about the percentage of population in Great Britain that has undiagnosed diabetes. A coincidence happened when this periodical featured a discussion of "The Doctor" painting in the March 2008 issue with "The Lancet" also featuring the same painting in its March 8, 2008 issue. Dr. Michael Balint's views on proper approach to general practice education published in 2006 by the Royal College of General Practitioners remains relevant.

In December 2015, an outbreak of pertussis was detected among staff working in the Maternity Unit of a district general hospital in Hampshire. This occurred in the background of increased pertussis activity in the community. The outbreak occurred over the Christmas holiday period causing staff shortages at a time when the departments were already overstretched. The high prevalence of upper respiratory tract infections at the time were difficult to distinguish from pertussis. This paper describes the outbreak, infection control measures implemented and the learning points. [ABSTRACT FROM AUTHOR]

Radicalisation and extremist violence are of increasing concern internationally. The unconventional, decentralised, and transnational nature of modern terrorism involves an active process of radicalisation requiring national security responses to reflect findings from recent empirical research. This study aims to identify factors that relate to extremist attitudes and potential vulnerability to radicalisation in order to inform preventative action. A cross-sectional survey was conducted of a representative population sample of men and women aged 18–45 of Muslim heritage recruited by quota sampling in two English cities. Logistic regressions were performed on a seven-item dichotomised measure based on our previously developed scale of 'sympathy for terrorist acts'. Scores representing 'non-condemnation of these acts' were deemed to represent risk for radicalisation. Thirteen respondents had a positive score on the sympathy for terrorism measure (2.4%), 39 scored zero (6.41%) and the remainder (91.4%) had a negative score representing condemnation of terrorist acts. There was a significant association between sympathy for terrorism and belonging to the local or global Muslim community, anxiety, and support for the use of defensive violence. Gender, religious identity, country of birth, belief in Sharia law, the importance of religion in life, and mosque attendance were all not associated with sympathy for terrorism. The results contribute to an understanding of the radicalisation process and have potential value in developing preventative public health interventions. [ABSTRACT FROM AUTHOR]

The UK government's leaders initially believed that it was among the best-prepared governments for a pandemic. By June 2020, the outcome of the collision between the government's initial confidence, on the one hand, and the aggressiveness and virulence of COVID-19, on the other, was evident. The UK had one of the worst COVID-19 mortality rates in the world. This article explores the UK government's response to COVID-19 from a public administration and governance perspective. Using factual information and statistical data, it considers the government's preparedness and strategic decisions, the delivery of the government response, and public confidence in the government. Points for practitioners: Possible lessons for testing through application include: Use the precautionary principle to set planning assumptions in government strategies to create the possibility of government agility during a pandemic. Use central government's leadership role to facilitate and enable local initiative and operational responses, as well as to take advantage of local resources and assets. Choose smart government responses that address tensions between the goal of saving lives and other government goals, and beware choices that are unsatisfactory compromises. [ABSTRACT FROM AUTHOR]

Aims: Considerable progress in public health is expected to occur from the application of genomic knowledge and technologies. This is the subject of a newly emerging field of public health genomics. In this paper we analyze differences in how public health genomics is developing in the Netherlands, the UK and Germany through the definition and diagnosis of familial hypercholesterolaemia (FH), an inherited predisposition for coronary heart disease. Methods: We analyzed the emergence of public health genomics within the framework of a project on the incorporation of genetics in western European healthcare schemes. Our analysis is based on document analysis and in-depth interviews. Results: In the Netherlands, public health genomics takes shape through a genetic screening programme for FH, looking for mutations on two specific genes; in the UK it emerges through a strategy of ‘‘mainstreaming’’ genetics in health care that aims to identify hereditary predispositions by means of phenotypic diagnosis; and in Germany public health genomics is elaborated at a conceptual level, leaving a diagnosis of FH to individual physicians who occasionally prescribe genetic testing. Conclusions: Our analysis shows how public health genomics gets constituted differently in different countries and, moreover, produces particular patterns of inclusion and exclusion from care. These patterns indicate a paradox in public health genomics, which consists of an inverse relationship between the use of advanced molecular genetic testing technologies and the number and variety of individuals at risk included in the target population. This paradox presents a challenge for professionals and policy makers in public health genomics. [ABSTRACT FROM PUBLISHER]

Employing a policy-as-discourse approach, we explore how the language of choice, risk and responsibilisation influences cardiovascular disease policy. We analyse four key pieces of public health literature produced in the UK between 1999 and 2013 that consider the prevention and treatment of coronary heart disease: Saving Lives: Our Healthier Nation; National Service Framework for Coronary Heart Disease; Mending Hearts and Brains and Cardiovascular Disease Outcomes Strategy. This critical discourse analysis problematises how neoliberal discourses of responsibilisation, risk and choice operate to govern health practices. Textual analysis reveals there are multiple dimensions evident in the way that responsibility for health is framed. Organisations are considered responsible 'for' illness prevention strategies and service provision, while individuals are conceptualised as responsible 'to' maintain healthy lifestyles. Conceptualising individuals as responsible health-conscious consumers enables a backward-looking narrative that holds individuals to account. Furthermore analysis reveals assumptions and messages that demonstrate the operation of moral discourses around patient behaviour. We suggest moral dimensions to public health strategies obscure the structural disparities that influence healthy life chances, imposing a system of limitations and exclusions that lead to allocation of liability and attributing blame for illness. [ABSTRACT FROM AUTHOR]

Comments on the impact of public opinion on the practice of public health in Great Britain. Necessity of the development of more constructive relationships with all sections of the media; Explanations concerning the difference between the population perspective on health statistics and those whose responsibility is to an individual patient; Controversy surrounding the uptake of measles, mumps, and rubella vaccine.

The article examines the local and regional economic impacts of NHS spending. The research is set in the context of tensions between buying economies, process efficiencies and local economic development impacts of public sector procurement, and contributes to the evidence base on supplier proximity and income retention at the local and regional level. The scale, scope and spatial distribution of NHS spending in a South Wales case are analysed using detailed purchasing information provided by a local health board. The article then uses an economic modelling framework to quantify the supply chain impacts of this spending to determine the full regional economic impacts of operational and capital expenditures. The analysis shows that NHS Wales spending supports significant levels of regional economic activity in terms of output, employment and gross value-added. The article also explores scenarios on the potential economic significance of import substitution of selected purchases. The implications of the changing procurement environment, with new EU directives, and a reorganisation of procurement functions within NHS Wales, are explored, and suggestions are made for further research. [ABSTRACT FROM AUTHOR]

Breastmilk is widely considered as the optimum nutrition source for babies and an important factor in both improving public health and reducing health inequalities. Current international/national policy supports long-term breastfeeding. UK breastfeeding initiation rates are high but rapidly decline, and the numbers breastfeeding in the second year and beyond are unknown. This study used the concept of liminality to explore the experiences of a group of women breastfeeding long-term in the United Kingdom, building on Mahon-Daly and Andrews. Over 80 breastfeeding women were included within the study, which used micro-ethnographic methods (participant observation in breastfeeding support groups, face-to-face interviews and online asynchronous interviews via email). Findings about women's experiences are congruent with the existing literature, although it is mostly dated and from outside the United Kingdom. Liminality was found to be useful in providing insight into women's experiences of long-term breastfeeding in relation to both time and place. Understanding women's experience of breastfeeding beyond current usual norms can be used to inform work with breastfeeding mothers and to encourage more women to breastfeed for longer. [ABSTRACT FROM AUTHOR]

England and Wales have experienced a decade of transformation concerning the legislative governance of urban public drinking spaces, yet the Evening and Night-time Economy (ENTE) retains its position at the top of ‘community safety’ agendas. This article reflects upon our research on alcohol law enforcement. We explore how some alcohol laws are ill-fit-for-purpose, whilst others are considered too difficult, or costly, to pursue. Subtle negotiations of compliance in which regulator and regulated form ‘partnerships’ are, at best, increasing trust and the flow of intelligence, and at worst, breeding complacency, inaction and regulatory capture. Gaps between headline statutory objectives and their delivery through policy implementation are being filled by corporate actors mobilising resources in line with central government predilections towards the outsourcing of control. In particular, the alcohol and hospitality industries promote ‘voluntary alternatives’ to the statutory roles and enforcement powers of city authorities and police. Replacing traditional law enforcement activity with self-regulation by alco-centric commercial interests is unlikely to assist attempts by public bodies, NGOs and other business sectors to engineer more diversified and inclusive urban nightscapes. [ABSTRACT FROM PUBLISHER]

In 2011, Hounslow public health opened a dialogue with probation, asking what the obstacles were, in terms of access to healthcare. The first issue raised was a difficulty in clients registering with a GP practice. This formed the start of a robust partnership between probation, public health, the forensic mental health practitioner, GPs and community health services. The health and well-being initiatives have included GP registration, with 10 dedicated practices for probation and Drug Intervention Programme clients, in-house stop smoking support, and the start of a health trainer scheme. This work will help to reduce health inequalities in a marginalized and underserved group and also meet the goals for both public health and criminal justice agencies [ABSTRACT FROM PUBLISHER]

The article presents a study which assessed the cost-effectiveness of conducting a randomized controlled trial (RCT) of medical screening for glaucoma within the framework of the National Health Service (NHS) in Great Britain. The researchers revised the Glaucoma Screening Model, conducted sensitivity analyses and calculated quality adjusted life years (QALY). The test paradigms for glaucoma were either optic nerve photography (ONP) or screening mode perimetry.

Availability of safe drinking water and immunisation have been the most cost effective public health measures. It is estimated that worldwide 2–3 million deaths are prevented annually due to immunisation. Herd immunity extends protection to the whole community but immunisation uptake needs to be high. This article aims to clarify the immunisation programme in the UK and to discuss the challenges GPs may face. Illustrative examples will demonstrate the challenges that practitioners may come across in their routine practice. [ABSTRACT FROM AUTHOR]

This piece has been written in response to a recent article published in the Times Higher Education Supplement (THES) which exposed the red tape restricting health research in the UK's National Health Service (NHS). Whilst the THES article was critical of NHS ethical review and research governance, it still views a streamlined version of the process as necessary for the protection of researchers and respondents. Drawing on the recent experience of applying for ethical approval and research governance for a qualitative study on gender and genetics, this paper examines the review process and the restrictive paperwork and procedures that surround it, focusing in particular on the impact this has on social science research. The argument will be put forward that while all research, whether clinical or social, is hampered by the bureaucracy surrounding the review process, social research is further alienated by it. This is because the paperwork and processes involved are set up to evaluate clinical, not social, research. Furthermore, the process is caught up in a culture of fear that breeds mistrust towards ‘outsiders’ wishing to conduct research in the NHS. The revision of NHS ethical review has to go further than mere bureaucratic streamlining - it needs to be made more relevant and accessible to health researchers working across a range of disciplines. [ABSTRACT FROM AUTHOR]

Public health specialists can be described as leaders of the ‘upstream health workforce’, concerned with preventing unnecessary and ‘revolving door’ contact with health services. Achieving this requires working to promote good health, improve health services and protect populations from infectious disease and environmental risks. Public health work is based upon the recognition that populations are complex constructions of groups of individuals, who may or may not seek help for health problems or be able effectively to take action to improve their own health. This article will define key areas of public health practice giving specific examples of the role of the public health specialist in the UK, as well as how and why primary care professionals might access specialist advice. The examples demonstrate the great potential for improving population health through the complementary efforts of primary care and public health professionals. [ABSTRACT FROM PUBLISHER]

The Health and Social Care Bill proposes clinically led commissioning. The new Clinical Commissioning Groups will become statutory bodies and replace the old primary care trusts. This primary legislation will transfer accountability for health care spending to clinicians who will have a duty to meet the health needs of a population as well as balance a budget. This change gives rise to a number of ethical issues which are explored in this article. [ABSTRACT FROM AUTHOR]

Language delay is a common developmental difficulty. Research indicates that it is influenced by environmental factors, particularly social deprivation, but that a parent’s interaction protects children’s language development against these factors. It is hypothesized that by supporting parents’ interaction, language development may be facilitated. This study aims to evaluate a preventative intervention for language delay. The Babytalk Home Visiting (BTHV) service was developed and delivered in Portsmouth, UK from 2003 to 2007. Two separate evaluations of the BTHV service were carried out, the first using parent questionnaires and the second using a comparative evaluation of parent ideas and child-language outcomes. In the first evaluation parents indicated that they valued the information given in the BTHV service, and 72.5% stated they would change their communication behaviour according to advice given. In the second evaluation, parents who reported receiving the BTHV service gave a significantly greater number of ideas on how to encourage language development, and reported a significantly higher child word count than parents who had not. The results of these evaluations suggest that this preventative initiative may be beneficial; however, limitations of the evaluation findings are discussed, and it is concluded that controlled comparative research is required to establish the effectiveness of such approaches. [ABSTRACT FROM AUTHOR]

The study, first published in 2003, looks at how trusts reacted to and implemented a safety alert on a drug, in this case potassium chloride, which can help save lives, but which is dangerous in high concentrations. [ABSTRACT FROM AUTHOR]

The ability to teach as a doctor in general practice (GP) is not only a requirement for the GP curriculum but is increasingly being recognized as a key skill for any doctor in the modern National Health Service (NHS). The recent guidance document from the General Medical Council, ‘Duties of a doctor’ clearly states: ‘Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future. You should be willing to contribute to these activities’. Long gone are the days when doctors were expected to know all they needed to know simply because they were doctors. New models of working and the drive for all new alternative providers of medical services practices to offer training mean that the ability to teach is also an attractive skill for you to offer to future employers. The types of people involved in teaching and learning in primary care are now more diverse than ever before. Working in a multidisciplinary team with other colleagues brings unique challenges that could see you feeling out of your comfort zone. This article will help you to feel more prepared to teach others, using the example of teaching about asthma. [ABSTRACT FROM PUBLISHER]

The author reflects on the issue concerning the cost in civil litigation in Great Britain. He states that claimant costs in clinical negligence litigation have been increasing, together with the number of cases being run under conditional fee. Application of the Article 2 to patient suicides: Savage versus South Essex Partnership NHS Foundation Trust is presented.

The article focuses on the use of antipsychotic drugs in treating dementia in Great Britain. It notes that antipsychotic medication in care homes has been discussed by the regulators but proper investigation on the use of the drugs was not given prior concern by the Commission for Healthcare Improvement (CHI) and the Healthcare Commission. A table of neuroleptics usage is presented.

The purchasing function was first developed within the British National Health Service as part of a quasi-market introduced by a Conservative government in 1990 and retained by the Labour government on coming to power in 1997. Since 2002 further reforms in England have begun to transform the quasi-market into a 'real' market with greater diversity of supplier, including from the private sector, a payment regime designed to reward additional hospital activity and new rights for patients to choose their provider. Evidence from the quasi-market era suggests that the purchasing function made little significant impact on services for patients or shifts in the pattern of hospital provision. The new market reforms, in theory, provide an opportunity to overcome prior weaknesses in the purchasing function. As this market develops, we suggest that the purchasers should develop three new sets of skills and activities if they are to be effective: the identification of need and shaping of demand; shaping the structure of supply; and holding the market to account. [ABSTRACT FROM AUTHOR]

The law in England allows that both parents and competent minors concurrently have the right to consent to medical treatment of the minor. This means that while competent minors may consent to treatment their refusal of consent does not act as an effective veto of treatment and treatment remains lawful if given with parental consent. This approach has been heavily criticized as inconsistent with the House of Lords decision in the Gillick case and damned as 'palpable nonsense'. In this article, I examine these criticisms and conclude that, far from being illogical, it is entirely consistent with the essential asymmetry between consent to treatment and refusal of treatment. I examine the two metaphors of keyholders and flak jackets used to explain this approach and I suggest that both have value but only when used in combination. I also explain why, contrary to the criticism, it is consistent with Gillick. [ABSTRACT FROM AUTHOR]

The article presents the third series of cases provided and discussed by clinical ethics committees in Great Britain. It states the tertiary services provided by Great Ormond Street Children's Hospital (GOSH) National Health Service (NHS) Trust to children in the region. In addition, it highlights questions regarding referral for a second opinion and the application of hysterectomy to prevent menstruation.