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Governments in many countries are increasingly interested in using community sport as a vehicle for improving public health through physical activity (PA) promotion. This has been associated with an increasing interdependence between the community sport and health policy sectors. However, there are no empirically grounded studies which have examined this directly and systematically in England. By examining Sport England's Get Healthy, Get Active (GHGA) initiative, this paper presents novel evidence derived from interviews held with strategic policy-makers from Sport England and a professional football charity (Everton in the Community), and 67 men who engaged in one of the GHGA funded programmes, Active Blues. The findings reveal how the increasing interdependence between community sport and health policy has been characterised by tightly contested and congested relations of power at local and national levels. Although Sport England was the lead organisation which coordinated and was accountable for community sport, it was nevertheless highly dependent on organisations outside of the sector, including health organisations, to deliver their community sport goals. This was indicative of the relatively vulnerable and marginal position which Sport England, and sport policy, occupied in the policy landscape and the associated generalisation of interests from sport to public health. The policy spillover from more powerful policy sectors such as health, to comparatively less powerful ones like community sport, raises questions about the degree to which government can realistically expect to achieve their formal community sport and health policy goals. [ABSTRACT FROM AUTHOR]

A growing number of researchers are trying to provide explanations for continuity and change in drug policy in different contexts. Such research predominantly falls in the pluralist realm of public policy where various actors compete to have their policy proposals accepted. Using a critical framework called Policy Constellations (PC), developed by Stevens and Zampini, this paper attempts to explain reactions of the British Government to Novel Psychoactive Substances (NPS) between 2008 – 2016. Qualitative data comes from in-depth interviews with stakeholders (N = 15), including NGO workers, a former Home Secretary, drugs ministers, governmental advisors, a former senior police officer, former Deputy Drug Coordinator, and a former Advisory Council for the Misuse of Drugs (ACMD) member. Two 'constellations' competed in British NPS policy setting. The PC framework illustrates power imbalances between these competing stakeholders. Abstinence orientated actors (the conservative constellation) enjoyed strategic advantages and media power which allowed them to create a favourable policy setting. These advantages were not enjoyed by the liberal constellation who struggled to access the policy setting and influence policy developments. The prohibitive nature of the policy used to counter NPS can be explained with the domination of actors whose values align with the conservative constellation. [ABSTRACT FROM AUTHOR]

As a result of a changing legal and policy context, statutory social work with adults in the UK has undergone a series of radical reforms. Underpinning these changes has been an ideological shift in the way adult social care should be provided. A clear 'direction' including a focus on autonomy, self-determination and personal responsibility is being promoted. These represent changes for both social workers and people receiving services. However, it has been suggested that policy may not fully acknowledge the factors that may undermine the ability of some individuals to take control of and manage their own needs. This paper draws on findings from two research projects, undertaken with social work practitioners located in statutory adult social care teams in the North East of England. The first explored the involvement of older people in adult safeguarding and the second considered capacity assessments and best interest decision making by social workers under the Mental Capacity Act [2005. Retrieved from ]. This paper presents key findings regarding how social workers attempt to reconcile the gap between the profile of the service user in policy and the reality of the people that social workers are supporting in practice. Key recommendations for policy, practice, and further research are also discussed. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

Explores the similarities and differences between the green paper and the earlier policy on the agenda to increase life expectancy in England. Decrease of inequalities in health; Targets of the legitimization of a concept for government actions; Comparison of the aims between policies 'The Health of the Nation' and 'Our Healthier Nation.'

Organ donation is constructed in the UK as a public responsibility, but more particularly as an obligation for members of minority ethnic communities. This paper draws attention to the ways in which ‘ethnicity’ has been made problematic by the allocation practices of transplant medicine, health promotion discourses and policy developments. Taken together, they have served to culturalise and racialise the procurement of organs. As the problem of organ donation is as much made inside medicine as outside it, this paper argues greater attention ought to be paid to these institutional practices and processes. Drawing on ethnographic work in the north of England, and with a specific focus on the organ consent encounter, this paper shows how categories of ethnicity in organ transplantation are an outcome of biopolitical and institutional practices. It argues that organ donation is best thought of, less as a discrete temporally-bounded act of decision-making, and more as a set of variegated situated practices that, in all manner of ways, problematically produce the publics that transplant medicine has come to rely upon so profoundly. [ABSTRACT FROM PUBLISHER]

This paper draws on the experiences of two researchers working to develop critical accounts of fatness with very different research participants – town planners and English Channel swimmers. Drawing across our encounters with these different participants, we explore the ‘doing’ of critical research through attending to the embodied encounters which take place in the ‘field’. In so doing, we reflect on moments where we have both, as part of the research encounter, not only found ourselves simply in fat-phobic contexts, but also effectively complicit in those contexts in our roles as interlocutors. In this paper, we explore the tensions inherent in those encounters for us (in all our multiple social, professional and embodied subjectivities), and ask what attending to these embodied confrontations (or the avoidance of confrontation) might mean for the critical research process – both in terms of the impact on practice and outputs of research for individual researchers and the participants with whom they are working. In doing so, we focus on what attention to the research encounter adds to debates about ‘impact’ in social science, about the doing of scholar-activism and about the role of the researcher’s body in the research encounter. [ABSTRACT FROM PUBLISHER]

This paper examines the multiple ways in which health policy relating to obesity, diet and exercise is recontextualised and mediated by teachers and pupils in the context of social class in the UK. Drawing on a case study of a middle-class primary school in central England, the paper documents the complexity of the policy process, its uncertainty, its intended and unintended affects and effects on the lives and bodies of young people as they negotiate ‘health’ across a range of social contexts. Particular attention is paid to the voices of young people, whom by way of embodying imperatives found in health discourses become ‘troubled bodies’, ‘emboldened bodies’, or ‘insouciant bodies’, as such imperatives intersect with pupils' various subjectivities. It is argued that whilst all pupils appear to be affected by health policy, they are differently effected by it. The paper will outline how pupils were effected by health policy in emboldened and privileged ways and how the young people seem to not only remain unscathed by health imperatives but are also positively emboldened and privileged by them. This paper adds to understandings of social class and relationships between public health discourse and individual (e.g. pupil) subjectivity, and highlights both the complexity of the policy process itself as a product of the organisational and social relations of schooling, as well as the complex and idiosyncratic nature of young people's embodied subjectivities. [ABSTRACT FROM AUTHOR]

In 2003 the English labour government placed a mandatory responsibility on local authorities to offer direct payments to all eligible people and are continuing to actively promote this service option. This paper explores some of the key reasons why the take-up of direct payments for mental health service users has been particularly slow compared to other user groups. The main themes of this article have been drawn from a large, detailed review of literature and research published between 2000 and 2006 and will provide practitioners and students with an overview of the key current implementation issues concerning direct payments in mental health services. Several major obstacles and dilemmas have contributed to low uptake including the legislation itself as well as local authority guidance. This paper discusses the documented confusion surrounding eligibility for mental health service users as well as the detrimental impact of fluctuating needs set in the context of a dual service provision of health and social care. Differing models of disability are discussed in addition to the fundamental process of recovery. The evidenced reluctance of practitioners and care co-ordinators to offer this service provision to mental health service users is considered, particularly their desire for power and aversion to risk taking. This paper concludes many social workers in mental health teams need to reappraise their current attitudes and practices to enable direct payments to become a viable and attractive service option. [ABSTRACT FROM AUTHOR]

There is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people residential group care can offer the best chance of positive outcomes, transition, and in some cases a route to permanence. With an emphasis on innovation, there has been a recent governmental focus on the role and purpose of these placements. This conceptual paper explores how the political and legislative context has influenced the current opinion and use of residential care, as well as examining the importance of factors such as attachment and relationships, parenting/intervention, the notion of home, a sense of belonging, and adolescent development. Evidence exploring associated risk and resilience factors is also discussed. We question whether adopting a child development perspective and moving the discourse away from placement type to placement purpose would better support children and young people to fulfill their life chances. Residential care undoubtedly offers a different experience to that of family-based care, although, further research assessing a wider range of attributable outcomes is necessary to understand how policy and practice can intervene to best support development and opportunity for children placed in out-of-home care. [ABSTRACT FROM AUTHOR]

Much public health research considers interventions that influence and are influenced by both individuals’ health and the society around them; this can be described as a complex system. We consider the role of explanation alongside statistical inference as crucial to obtaining credible and useful insights, particularly in light of concerns about a ‘crisis of replication’, and reflect on the difficulty in researching complex systems. In this paper, we make a connection with Lipton’s philosophy of inference to the best explanation, and offer some tentative practical recommendations, extending suggestions from different fields. An extended hypothetical example is given on introducing ‘sugar tax’ in England. [ABSTRACT FROM PUBLISHER]

Professional sports clubs (PSCs) are potentially effective settings for health promotion; however, their role within policy is unclear. Potential reasons include lack of awareness about existing provision of health and wellbeing (H&W) programmes and adequacy of monitoring and evaluation (M&E) practices. This review aimed to: (i) map the provision of H&W programmes delivered by PSCs in the United Kingdom (UK), and (ii) explore current M&E practices of PSCs and consider the policy implications of this. Websites from eight professional sport leagues were hand-searched for programmes and impact reports. Suitable programmes were quantified, whilst impact reports were analysed via inductive documentary content analysis. Results identified 176 H&W programmes and 36 impact reports, as well as 43 H&W impact statements, but only 14 of these were aligned to specific H&W outcomes. The H&W aims of programmes were typically vague, measurement tools were rarely used, and evaluations were usually anecdotal case studies and based on engagement figures, which may not only limit the potential uptake of these programmes but also the relevance of PSCs to public policy. Further research is thus needed to build a stronger evidence base for the use of PSCs as vehicles of public health promotion and policy, and to better address the challenges faced when seeking to monitor and evaluate PSC programmes effectively. [ABSTRACT FROM AUTHOR]

In England, health inequalities policy shifted during the Labour term (1997–2010) from initially strong commitments to tackling the ‘upstream’ social determinants of health to a technically-driven emphasis on lifestyle risk factors and healthcare access. This multi-sited study, based in and around Westminster (2006–2007), extends our understanding of how political context influences policy-making by drawing from anthropological studies of policy. Qualitative material from central government is put into conversation with theory concerning policy as zones of practices. The paper explores the bristly process through which public health, healthcare and corporate interests vied to shape the political agenda for health inequalities; the selective use of evidence by civil servants in accordance with their perceptions of what politicians conceive to be electorally palatable; the silencing of critique of the dominant narrative about evidence-based policy; and how technical aids developed a life of their own – as a result of which, health inequalities policy ended up being depoliticised. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to consider 'New' Labour's socio-economic and health policies, discuss how they influence preventive health strategies aimed at men, and identify the implications for managers, researchers and practitioners working to improve public health in the primary care sector in England. Policy, theoretical work and empirical research are analysed, critically, to develop the arguments in the paper. Although men may be perceived as a 'hard to reach group', insufficient consideration has been given to how health policy facilitates or restricts successful preventive health work with men. The 'gender duty', which has recently been introduced in England, presents an opportunity to build on earlier successful public health work with men. There is some evidence that innovative public health strategies, informed by an understanding of gender, with men are being developed. This may enable primary care trusts to more successfully, and creatively, target and engage men in health improvement activities. However, the current dominant ideology in public health policy in England is grounded in a perspective that emphasises biomedical, neo-liberal and psychological explanations of health and which neglects the relationship between gender and health inequalities. Recognition of the links between gender, poverty, and the concomitant inequalities, is a priority when planning preventive health work with men. If such inequalities are to be redressed, social and economic policies underpinned by values of equity and social justice are needed, incorporating a more nuanced understanding of the role of gender in health. [ABSTRACT FROM AUTHOR]

Different versions of choice are at work in England's National Health Service. A hard version of choice associated with provider competition (and patient exit) appears to be giving way to a 'softer' concept of 'personalization', emphasizing choice and voice at the micro level, but also drawing on solidaristic themes. As personalization becomes increasingly central to health reform, it is important to interpret the ways in which a personalization narrative is being used. It is also necessary to trace its ambivalent framing of National Health Service patients, staff and structures. This paper uses textual analysis to explore how personalization has been positioned in ministerial speeches and health policy documents. It finds that personalization is located in a discourse of organizational decline and disruption, emphasizing the need for patient exit and voice as recuperative mechanisms, but also one of consolidation, trust and equity, emphasizing loyalty to shared welfare services. Hirschman makes clear that an interplay between exit, voice and loyalty is to be expected. However, there is an ambivalence in their relationship which is being ignored by health policy-makers. Frontline staff and service users are left to negotiate an agenda which positions them as both partners and adversaries. [ABSTRACT FROM AUTHOR]

This paper critically examines the public policy environment that underpins the politics of health promotion in England. English health policy from the late 1970s to the mid 1990s was not receptive to health promotion. The new Labour government elected in 1997 claimed to embrace a 'Third Way' between the free market and socialism that would appear to embrace a community-centred approach to health promotion that would through partnership-building promote equity; perversely, however, the election of this government rhetorically committed to healthy public policy was accompanied by a crisis in health promotion delivery. Despite apparent commonalities between the Third Way and health promotion, the Third Way was in many respects a neoliberal ideology and so has contributed to the marginalisation of health promotion. Although some might argue that health promotion has been mainstreamed, it is argued here that in terms of the crucial National Health Service infrastructure underpinning the health promotion movement, that the organisational capacity for health promotion has been significantly weakened. Thus the question is how you revive a movement that has lost its way? The answer must include taking a historically informed approach to analysing the problem and identifying solutions. Wider systems issues in England include the emergence of multidisciplinary public health, the sequence of changes to national health promotion organisations and the wider marginalisation of the public health movement. It is only by critically analysing and addressing these systemic issues that the prospects for health promotion in England can be revived. [ABSTRACT FROM AUTHOR]

A growing number of countries are beginning to move from acknowledging the existence of health inequalities to developing policies to reduce them. Many of these policies consist of complex interventions, operating at a number of levels, which aim to make a positive contribution to health improvement in deprived communities. Evaluating the efficacy of such initiatives poses particular challenges for evaluation. This paper argues that there is real potential in applying a theory-based approach to the evaluation of complex community-based initiatives. Using practical examples from the national evaluation of Health Action Zones in England, the paper outlines the key components of such an approach and argues that theory-based evaluation can strengthen programme design and implementation, as well as promote policy and practice learning about the most effective interventions for health improvement. We conclude that sophisticated theory building social change mechanisms in community settings is essential if real learning is to be generated from concerted efforts to achieve social change. [ABSTRACT FROM AUTHOR]

Background Health literacy is important because of the high proportion of the population with skills below those needed to become and stay healthy, and the resultant negative impact on people's lives. A recent study in England has shown that, as is true in other industrialized nations, a significant proportion of people (43–61%) have literacy and numeracy skills below those needed to fully understand and use health materials. This paper describes a project designed to build on these findings with key stakeholders to develop an action plan to address a mismatch between population skills and the health system complexity. Method The multi-stage project involved an initial meeting of stakeholders that allowed participants to share knowledge and experience, and make suggestions for change. Subsequent web-based surveys enabled widening of the stakeholder group, identification of further potential actions, and participant rating of the impact of the suggested actions on this mismatch. Next, a meeting enabled the group to identify priorities for change that would be feasible and cost-effective. Results Forty-one participants were recruited from a range of patient, health, lifelong learning, civil service, and industry perspectives. Suggested topics for action fell into four areas; improving health services, building health literacy skills in the population and workforce, recognizing the importance of public information developed outside the health arena, and funding for health literacy research and development. Following consideration of likely cost, impact, and feasibility, five suggested areas were prioritized for action, three involving improvements in the health service, and two involving the development of public health literacy skills. The importance of inter-sectoral approaches to this complex issue was identified. Discussion This project recruited key stakeholders with a wide range of relevant expertise and perspectives. It resulted in a clear, coherent action plan to address the population skills: health system complexity mismatch. Next steps include implementation, evaluation, and widening to other areas of life important to public health and well-being such as public safety messages and social care. [ABSTRACT FROM AUTHOR]

Policy exhortations for promoting outdoor physical activity have increased considerably in England and Wales over the past 20 years. Despite a considerable number of schemes developing during this period to encourage physical activity and exercise, marked population-level changes in outdoor physical activity behaviour have not been seen. The paper explores the triggers to this participation using a five-fold classification: physical infrastructure; information infrastructure; administrative infrastructure; participant constraints and participant preferences. Through a series of interviews in a case study ‘healthy exercise’ scheme in South Staffordshire, a district local authority in England, these triggers to participation are identified and explored. It is concluded that whilst the infrastructure triggers can be manipulated by scheme providers in an attempt to improve scheme participation, participant triggers fall largely beyond the control of scheme providers. Research suggests, too, that participant triggers tend to be stronger than infrastructure ones. Because of this, where there is a lack of healthy exercise scheme success, this cannot necessarily be attributed to scheme providers as it might be as a result of user triggers. For the same reason, it might be beyond the influence of scheme providers to turn ‘failing’ exercise schemes into successful ones. [ABSTRACT FROM AUTHOR]

Recent health policy in England has demanded greater involvement of patients and the public in the commissioning of health and social care services. Public involvement is seen as a means of driving up service quality, reducing health inequalities and achieving value in commissioning decisions. This paper presents a summary and analysis of the forms that public involvement in commissioning are to take, along with empirical analysis from a qualitative study of service-user involvement. It is argued that the diversity of constituencies covered by the notion of 'public involvement', and the breadth of aims that public involvement is expected to achieve, require careful disaggregation. Public involvement in commissioning may encompass a variety of interest groups, whose inputs may include population needs assessment, evaluation of service quality, advocacy of the interests of a particular patient group or service, or a combination of all of these. Each of these roles may be legitimate, but there are significant tensions between them. The extent to which the structures for public involvement proposed recognize these possible tensions is arguably limited. Notably, new Local Involvement Networks (LINks), which will feed into commissioning decisions, are set as the arbiters of these different interests, a demanding role which will require considerable skill, tenacity and robustness if it is to be fulfilled effectively. [ABSTRACT FROM AUTHOR]

An increase in the participation rates of British South Asian Muslim communities in sport and physical activity is a high priority in both the sport and health sectors. Interventions emanating from the sport development sector have to date achieved little significant growth of activity. However, interventions within the health sector appear to be more successful in engaging South Asian communities in activity. This paper is based on field research in a Healthy Living Centre in Blackburn, a town with a large South Asian Muslim community. The research suggests that within such communities a mode of delivery grounded in physical activity and personal health is likely to be more successful than one based on sport and competition. However, it also identifies other cultural factors that will need to be addressed if participation rates are to be further increased. [ABSTRACT FROM AUTHOR]

This article examines how deaths related to mental health in England and Wales are investigated and the extent to which lessons are learned in their aftermath. It uses two concepts from academic literature to discuss organisational responses to these deaths: organisational learning, and organised irresponsibility. Organisational learning stresses the importance of learning lessons from data; in contrast, Beck's concept of organised irresponsibility states that organisational lesson learning is impeded by the fragmented and risk-averse nature of public institutions. The article considers 210 organisational responses to Reports to Prevent Future Deaths (PFDs) issued by Coroners. PFDs are sent to any organisation Coroners believe could act to prevent future deaths. The article identifies three findings: Firstly, organisations tend to produce generic responses rather than addressing specific issues raised by Coroners. Second, organisations tend to cite existing policies as responses to Coroners despite those policies not preventing specific deaths. Third, institutions seek to displace blame onto other organisations in attempting to avoid accepting responsibility for the death. The article adds to the canon of knowledge on deaths in healthcare, and in the care of the state by identifying significant structural weaknesses that impede organisational lesson learning about preventable deaths. [ABSTRACT FROM AUTHOR]

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular 'upstream-downstream' story, and what it means to work 'upstream' to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants' research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences. [ABSTRACT FROM AUTHOR]

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

Background: In 2017 a national policy framework for advanced clinical practice in England was introduced by Health Education England, to establish clarity around the level of practice. Whether the implementation of this framework has resulted in adoption of advanced clinical practice into public and workplace jurisdictions is yet to be explored. Aims: This health service workforce evaluation aims to explore the views and opinions of Advanced Clinical Practitioners and trainees in England on their experiences since the implementation of the 2017 framework. Methods: This is secondary analysis of a workforce dataset. A self-completed questionnaire was distributed via the Association of Advanced Practice Educators United Kingdom aimed at those undertaking Advanced Clinical Practitioner education or who are practicing at this level. Semi-structured phone interviews were carried out with a subset of this group on their views and opinions to obtain depth of insight. Questionnaires were summarized using descriptive statistics in Excel and interviews analysed using thematic analysis. Results: The identity of the advanced clinical practitioner role is developing. Of questionnaire respondents, 29% thought their line manager didn't understand their role, and 42% thought that patients didn't understand their role. Three quarters (75%) had access to clinical supervision. Interview respondents reported restriction in their role as a result of a perceived lack of understanding and awareness from colleagues. Interviewees reported that they had to spend time explaining their role to colleagues, patients and managers. Conclusions: Advanced Clinical Practitioners in this evaluation perceived a lack of clarity and understanding around their role from their colleagues, patients and managers. Relevance to clinical practice: This suggests that Advance Clinical Practitioners are currently under-prepared to negotiate jurisdictions, a key aspect in the introduction of a new role. [ABSTRACT FROM AUTHOR]

Since 2005, reforms in the National Health Service in England, overseen by the British government's Department of Health (DH), have further stimulated a market by increasing the number of providers and encouraging patient choice. This study compares the DH's reporting until 2010, on its website, of ‘what patients want’ and the research evidence for its statements. It will consider whether the evidence is more ambiguous than the website summary implied; obscuring the voices of those with opinions running counter to patient choice, as the DH defined it. Finally, it reflects on whether there has been a subsequent change of approach. [ABSTRACT FROM AUTHOR]

We explore the development of two proposed Social Impact Bond (SIB) financed interventions in the UK. This is important because little is known about the processes involved in the localised development of these nascent financing mechanisms. We apply a "decentred" approach to network governance to the case studies – one in which a SIB financed intervention was initiated and another in which it was not. Moving from the prevailing competitive quasi-market commissioning traditions to new forms of integrated commissioning requires a more collaborative approach to service procurement than has typically been the case thus posing dilemmas for the relevant networks. [ABSTRACT FROM AUTHOR]

Countries with aging populations require people to remain independent for as long as possible to reduce pressures on health and care services. England has an old housing stock, low replacement rates and little specialized housing for older people. There is grant assistance to adapt homes, but resources are restricted and service pathways complex. This article charts the findings of change management projects and national reviews that show that reform is hampered by a lack of robust data about the financial benefits of adaptations. Better evidence is needed to give housing issues greater prominence in health and care planning. [ABSTRACT FROM AUTHOR]

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An international research collaboration answered, “Can equity in perinatal health for migrant women be measured for comparison across countries?” In nine countries, perinatal databases were assessed for the availability of equity indicators. Equity data were also sought from women and health records. Optimal sources of data differed depending on the migrant perinatal health equity indicator. Health and migration data, required to capture equity, were often not reported in the same location. Migration indicators other than country of birth were underreported. Perinatal health equity can be measured for international comparisons, although a standardized protocol is required to capture all indicators. [ABSTRACT FROM PUBLISHER]

When discussing contributions from psychology in/to educational practices like school-based mental health promotion, it is peculiar that psychologists (of an educational or clinical kind) or education-oriented sociologists, both not often based in schools or classrooms, dominate the topic. It has been acknowledged that school staff have been over looked and underutilised in contributing to the discussion, particularly as this pertains to sharing perspectives on how they experience their role in relationship to education policy and practice. The study presented here looked to address this situation by seeking the perspectives of school staff on a range of concerns situated at the nexus between education and psychology. Contrary to the type of displaced assessment intimated above, this group of school staff generally accepts they perform a crucial task in supporting students, their main concern being to incisively question how they might negotiate existing role-related pressures to better current school-based practice. [ABSTRACT FROM AUTHOR]

Increasing sport participation has been identified as a key vehicle for achieving World Health Organisation guidelines for health-enhancing physical activity (HEPA). A policy challenge is to promote this changed behaviour. Making use of the Active People Survey, a zero-inflated ordered probit model is used to identify the covariates of sport participation for males and females with respect to the related decisions to either participate in sport or not, and to participate at either lower or higher than desired intensity. To inform current policy emphases, the Active Places Survey is also used to examine the causal impact of facility provision on these behaviours. Results indicate that females are more likely to adopt less intensive activity even with time available. Families could place most constraints on females, but also reduce the intensity of male participation. Education has a greater association with higher intensity female activity. The largest effects are identified for sport club membership and facility satisfaction. Both of these affect male intensity of activity most. The main policy challenges facing sport in contributing to HEPA are shown to involve retaining male intensity of participation when ageing and encouraging greater female intensity of participation, with more appropriate matching of facilities. [ABSTRACT FROM AUTHOR]

Today, qualitative researchers are framing the relationship between qualitative case studies and quantitative evaluation research in positivist terms, seeking dialogue with quantitative researchers on the basis that qualitative case studies hold the potential to develop theory for evaluation programmes and to improve the quality of quantitative research. In the UK health policy literature, however, recent evaluations of major government programmes of reform have been conducted under largely quantitative and econometric strategies involving baskets of indicators, or routinely collected hospital statistics, set against the central stated aims of the programme: namely, to improve quality, efficiency, responsiveness, output and equity. For the wider evaluation literature, we detail the results of a qualitative case study of the impact of two key reforms, the 18 Week Patient Pathway and Payment by Results, on four English hospitals, demonstrating the value of the positivist frame to evaluation research based on its capacity to improve understandings of cause and effect and to direct quantitative researchers towards better measures and data sets. For the UK health policy literature, we demonstrate the value of qualitative case studies to the policy process in terms of their potential to reduce the risks for serious policy mistakes. [ABSTRACT FROM PUBLISHER]

An audit of baseline compliance with contemporary health care policies pertinent to the care of young people in hospital was undertaken in 1 large English District General Hospital. Children's and adult services within the hospital were benchmarked against the government audit tool standards. The aim of the study was to identify good and less optimum compliance to best practice policy driven benchmarks of care, using a 1-4 scale. Each clinical area within the hospital was contacted to make arrangements with members of the inter-professional team to complete the baseline benchmarking exercise. The audit was conducted over 3 days and the majority of the evidence sourced comprised of documented evidence and verbal affirmation of the individual perceptions of key informants of how the various clinical areas scored against the best practice benchmarks. Scores of policy compliance in some clinical areas of the hospital ranged from 1 not yet started (non-compliant) through to 4 you're welcome (fully compliant). The results demonstrate that many of the clinical areas within the hospital are making good efforts to ensure full compliance to policy guidelines and mandates. There are some aspects of policy standards that hospital has yet to fully embrace. This initial benchmarking exercise on behalf of 1 English hospital has revealed some areas of outstanding and good practice which have the potential to be shared. [ABSTRACT FROM AUTHOR]

English mental health policy has explicitly supported a focus on recovery since 2001. More recently, this has been elaborated through policy support for social inclusion, employment and well-being. We review several drivers for this political orientation, including a refocusing of the role of health services as a whole from treating illnesses to helping people to make the most of their lives, the shift to greater power for the individual, reflected in personal social care and personal health budgets, and the evidence informing clinical guidelines issued by the National Institute for Health and Clinical Excellence (NICE). A disjunction remains between policy and practice, with organizational policies espousing a recovery orientation and teams re-branding as 'recovery and support' teams, whilst pursuing clinical practices which prioritize symptomatic treatment rather than recovery support. The next phase of development in English statutory mental health services is therefore bridging this gap, through organizational transformation in mental health services towards a focus on recovery. We describe two funded initiatives to support this process of organizational transformation. The first (ImROC) is a national initiative to develop a pro-recovery organizational climate. The second (REFOCUS) is a multi-site cluster randomized controlled trial (ISRCTN02507940) investigating a team-level pro-recovery intervention. [ABSTRACT FROM AUTHOR]

One of the strengths, contemporaries argued, of Britain's pre-NHS voluntary hospital system was that, unlike the monolith that replaced it, its provision was organically guided by, and responsive to, the direct needs of the community it served. The hospital was not simply a place of medicine but an active and symbiotic cultural site, where local people came together to further joint needs; a place of overarching pride and attachment. Yet the relationship between the community and hospital was set to change as working-class payments increased as a proportion of hospital income, so that financial costs were now more broadly shared across the classes. Did then local people truly come to view the hospital service as belonging to them - as 'ours' - gifted through their various fundraising and locally organized insurance contributions? Or was this more rhetoric, provided by those appealing for funds and resisting state intervention? [ABSTRACT FROM AUTHOR]

The connected care pilot in Hartlepool has been commended in government documents for its potential to 'put people in control' and, thereby, enable them 'to shape improvements in provision and contribute to greater fairness in service use'. This article focuses on the development by that pilot of a 'model' for community commissioning which residents were centrally involved in designing and operationalizing. It aims to describe how far and in what ways community members helped to shape those processes so that the pilot 's implications for promoting community commissioning can be identified and consolidated. [ABSTRACT FROM AUTHOR]

Background : Few studies have estimated the full costs of moving people from long-stay psychiatric hospitals to community residence. Fewer still have examined the long-term implications of this important component of mental health policy. Aims : To assess the full service and cost implications of community care for people who moved from long-stay psychiatric hospitals 12 years ago. To explore the associations between costs and people's characteristics, needs and outcomes. Method : Data were collected from 128 people in seven English localities that were part of the 1983 Care in the Community Initiative . For a sub-sample of 75 people, changes in resource use between 1 and 12 years after leaving hospital were assessed. Results : Most people live in staffed accommodation supported by a range of community-based services. Mean community care costs (£555 per week) are lower than long-stay hospital residence or community costs 1 year later. Conclusions : High support homes, in-patient beds, and day care services are costly but important care components. The low utilization rate of general practitioners is concerning given residents' increasing age. There was no evidence to suggest the reduction in costs was a response to reductions in user needs. Declaration of interest : The Department of Health funded the research. [ABSTRACT FROM AUTHOR]

Information about the Chief Scientific Officers Conference held in London, England from November 25-26, 2008 is presented. Topics included the amendments of the National Health Service (NHS) Constitution, major areas of the NHS including NHS hospital, Primary Care Trust and Foundation Trust as well as the innovation in the healthcare industry. The conference featured several notable speakers including David Nicholson, Gail Richards and Julie Moore.

The article presents abstracts of studies presented at the British Institute of Musculoskeletal Medicine Winter Symposium in London, England in December 2013. Topics covered include the barriers to muscoleskeletal care, impact of policies on integrated care, and the use of software to manage chronic pain.