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Watchful waiting is a concept that is traditionally not associated with severe and enduring mental illness. This paper, however, boldly argues that the concept could be used as a ground‐breaking and accessible antidote to the perceived inequality experienced by black service users experiencing both mild and severe mental illnesses in England. The novel concepts proposed in this paper are not intended to be consensual, but rather uncompromising to provoke critical thinking in mental health practice. A conceptual framework for watchful waiting in mental health is suggested. [ABSTRACT FROM AUTHOR]

This paper provides an account of an innovative research project that enabled the co‐creation with justice‐involved young people of a transformative framework of practice, termed Participatory Youth Practice (PYP). We present a description of our participatory research processes and reflect on our attempts to rebalance inherent power dynamics when working with marginalised young people. We demonstrate how young people's meaningful participation in research can strengthen their participation in service design and delivery. The embedding of the PYP framework in youth justice practice across a large region in England is a formative step in understanding the importance of young people's participation. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses some key findings taken from a qualitative study conducted with gay and lesbian adopters and foster carers in England and Wales. The study examined the experiences of 24 self‐identified lesbians and gay men, who had been involved in adoption or fostering processes since the introduction of the Adoption and Children Act, 2002. This article will explore why participants chose to adopt or foster and their approach to relationships generated through these routes. Findings indicate that gay and lesbian applicants troubled dominant conceptualisations of family and kinship and revealed both heteronormative and nuclear constructions of parenting within adoption and fostering social work. In contrast, participants often demonstrated a reflexive and creative approach to caring for looked after children. This paper will therefore consider how professionals can recognise nuanced or complex relationships, situated beyond traditional frameworks, through drawing upon wider concepts within sociological literature. [ABSTRACT FROM AUTHOR]

The professed aim of any social welfare or legal intervention in family life is often to bring about "better outcomes for the children." But there is considerable ambiguity about "outcomes," and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009–2010 and the others in 2014–2015. The paper considers the challenges of achieving and assessing "good outcomes" for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of "normal" child development, and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings. [ABSTRACT FROM AUTHOR]

The Office for Standards in Education, Children's Services and Skills (Ofsted) is responsible for inspecting services that care for children and young people in England and Wales. This paper presents findings from an independent study of Ofsted inspections into children's social care in England, covering reports under three inspection frameworks during the period 2009 to 2016. The research aimed to identify the main themes of recommendations made in Ofsted reports and to explore similarities and differences between frameworks and between local authorities. The methodological approach was document analysis. A stratified sample of 60 reports was prepared on the basis of inspection framework and local authority characteristics such as local deprivation, Ofsted rating, and urban/rural category. A thematic analysis was conducted of the recommendations in each report, with emerging themes subjected to an iterative process of coding and categorization. The findings identified nine categories of themes, the most common of which were performance management, casework, oversight of practice, and multiagency working. Overall, the recommendations were strongly oriented towards process issues and compliance with standards. Recommendations were found to differ somewhat between inspection frameworks but remained largely consistent between local authorities with different characteristics. The paper concludes by examining the implications of findings for the current regulatory framework in children's social care. [ABSTRACT FROM AUTHOR]

This paper critically explores how survey and routinely collected data could aid in assessing the generalisability of public health evidence. We propose developing approaches that could be employed in understanding the relevance of public health evidence, and investigate ways of producing meta‐analytic estimates tailored to reflect local circumstances, based on analyses of secondary data. Currently, public health decision makers face challenges in interpreting global review evidence to assess its meaning in local contexts. A lack of clarity on the definition and scope of generalisability, and the absence of consensus on its measurement, has stunted methodological progress. The consequence of failing to tackle generalisability means that systematic review evidence often fails to fulfil its potential contribution in public health decision making. Three approaches to address these problems are considered and emerging challenges discussed: (1) purposeful exploration after a review has been conducted, and we present a framework of potential avenues of enquiry and a worked example; (2) recalibration of the results to weight studies differentially based on their similarity to conditions in an inference population, and we provide a worked example using UK Census data to understand potential differences in the effectiveness of community engagement interventions among sites in England and Wales; (3) purposeful exploration before starting a review to ensure that the findings are relevant to an inference population. The paper aims to demonstrate how a more nuanced treatment of context in reviews of public health interventions could be achieved through greater engagement with existing large sources of secondary data. [ABSTRACT FROM AUTHOR]

While many evidence-based tools and measures exist to support child protection practice, in the United Kingdom, there is little evidence of their routine use in casework. This paper reports on a qualitative study exploring the use of such tools with children and families receiving statutory social care services. Fifteen social workers working in child safeguarding teams in two local authorities in Southeast England agreed to incorporate the use of outcome measures into their casework over a 6-month period. Qualitative data were collected through monthly action learning workshops held separately in each local authority. The results showed how the impact of using the measures was shaped by a combination of institutional factors, practice context and the dynamics of casework. Outcome measures were found to have benefits as well as limitations with respect to partnership working, assessment and decision-making and overall social work practice. Implications are discussed for the prospects of enhancing the use of evidence-based tools in statutory social work with children and families. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores practical and ethical dilemmas for professionals when securing the protection of children in the complex non‐clinical setting of individual families. It is based on a cross‐country study on cultural encounters in interventions against child physical abuse and neglect in four countries (England/Wales, Germany, Portugal, and Slovenia). Drawing on national reports of legal‐organizational frameworks and socio‐cultural backgrounds of European child protection systems, it also presents the results of a series of focus groups with professionals. Data were analysed to identify implicit and explicit discursive constructions as well as normative representations and from this deriving the key ethical issues and dilemmas. Despite a shared normative framework across Europe, intervention cultures vary across the four countries and between the different stakeholder groups. Although each child protection system faced widespread mistrust, policy approaches differ, some relying on strong and detailed guidance whereas others stress professional skill and judgement. We conclude that despite a shared commitment to the protection of children, deliberations and perceived ethical dilemmas suggest interdependency between differences in system cultures and policy approaches that inform the character of professional interventions in the four countries. [ABSTRACT FROM AUTHOR]

Value sets for the EQ-5D-5L are required to facilitate its use in estimating quality-adjusted life years. An international protocol has been developed to guide the collection of stated preference data for this purpose and has been used to generate EQ-5D-5L valuation data for England. The aim of this paper is report the innovative methods used for modelling those data to obtain a value set. Nine hundred and ninety-six members of the English general public completed time trade-off (TTO) and discrete choice experiment (DCE) tasks. We estimate models, with and without interactions, using DCE data only, TTO data only, and TTO/DCE data combined. TTO data are interpreted as both left and right censored. Heteroskedasticity and preference heterogeneity between individuals are accounted for. We use Bayesian methods in the econometric analysis. The final model is chosen based on the deviance information criterion (DIC). Censoring and taking account of heteroskedasticity have important effects on parameter estimation. For DCE data only, TTO data only, and DCE/TTO data combined, models with parameters for all dimensions and levels perform best, as judged by the DIC. Taking account of heterogeneity improves fit, and the multinomial model reports the lowest DIC. This paper presents approaches that suit observed characteristics of EQ-5D-5L valuation data and recognise respondents' preference heterogeneity. The methods described are potentially relevant to other value set studies. [ABSTRACT FROM AUTHOR]

This paper examines the discretionary reasoning of the judiciary in three jurisdictions, England, Germany and Norway, in cases deciding whether a newborn child is safe with her parents or intervention is necessary. Our analysis focuses on one specific dimension of decision makers' exercise of discretion, namely, if and how the strengths and weaknesses of the mother are considered. The data material consists of all decisions concerning care orders of newborns from one large city in Germany from 2015 to 2017 (n = 27) and 2016 in Norway (n = 76) and all publicly available newborn removal decisions in England for 2015–2017 (n = 14). The findings reveal a high number of risk factors in the cases and less focus on risk‐reducing factors. The situation of the newborn is considered to be harmful, as most cases result in a care order. Judicial discretion differs by how much information, and what types of factors, are included in the justification for the decision. A learning point for decision makers and policymakers would be to actively undertake a balancing act between risk‐increasing and risk‐reducing factors. [ABSTRACT FROM AUTHOR]

In the wake of the 2011 'riots', public order policing tactics in England and Wales have once again been brought into question. Yet, the riots came two years since police regulatory authorities in the UK called for fundamental reforms to the policing of public order. Questions are raised about why the change called for appears to have been so slow and what can be done to assist reform. This paper suggests that developing an evidence-based policing approach within the field of public order policing to inform police decision-making would provide the answers. By doing so, the paper addresses some of the possible barriers to implementing evidence-based policing in public order and calls for police academic partnership to overcome these to make 'change' an ongoing reality. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper reports on an empirical study of child protection services in a local authority where rates of investigations and interventions rose to unprecedented levels during the course of a single year. The aim of the research was to explore explanations for this rise in demand among the providers of children's social care in the area. Using an interpretative qualitative design, a series of focus groups and interviews were carried out with practitioners and managers (n = 25) from statutory services and Early Help. The findings identified a combination of long‐term and short‐term drivers of demand. Long‐term factors emphasized the impact of rising levels of deprivation combined with cuts to community‐based services for children and young people. Short‐term factors ranged from a more proactive approach to child neglect to more effective multi‐agency partnerships and joint decision making. The interaction between these factors was found to be accentuating an underlying shift to "late intervention" across the sector. The findings are contextualized in relation to contemporary debates about the crisis of demand for children's social care and the complex relationship between prevention and protection. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Decisions about whether to refer or admit a patient to an intensive care unit (ICU) are clinically, organizationally, and ethically challenging. Many explicit and implicit factors influence these decisions, and there is substantial variability in how they are made, leading to concerns about access to appropriate treatment for critically ill patients. There is currently no guidance to support doctors making these decisions. We developed an intervention with the aim of supporting doctors to make more transparent, consistent, patient‐centred, and ethically justified decisions. This paper reports on the implementation of the intervention at three NHS hospitals in England and evaluates its feasibility in terms of usage, acceptability, and perceived impact on decision making. Methods: A mixed method study including quantitative assessment of usage and qualitative interviews. Results: There was moderate uptake of the framework (28.2% of referrals to ICU across all sites during the 3‐month study period). Organizational structure and culture affected implementation. Concerns about increased workload in the context of limited resources were obstacles to its use. Doctors who used it reported a positive impact on decision making, with better articulation and communication of reasons for decisions, and greater attention to patient wishes. The intervention made explicit the uncertainty inherent in these decisions, and this was sometimes challenging. The patient and family information leaflets were not used. Conclusions: While it is feasible to implement an intervention to improve decision making around referral and admission to ICU, embedding the intervention into existing organizational culture and practice would likely increase adoption. The doctor‐facing elements of the intervention were generally acceptable and were perceived as making ICU decision making more transparent and patient‐centred. While there remained difficulties in articulating the clinical reasoning behind some decisions, the intervention offers an important step towards establishing a more clinically and ethically sound approach to ICU admission. [ABSTRACT FROM AUTHOR]

This paper examines the challenges facing English flood risk management (FRM) policy and practice when considering fair decision-making processes and outcomes at a range of spatial scales. It is recognised that flooding is not fair per se: the inherent natural spatial inequality of flood frequency and extent, plus the legacy of differential system interventions, being the cause. But, drawing on the three social justice models – procedural equality, Rawls’ maximin rule and maximum utility – the authors examine the fairness principles currently employed in FRM decision-making. This is achieved, firstly, in relation to the distribution of taxpayer's money for FRM at the national, regional and local levels and, secondly, for non-structural strategies – most notably those of insurance, flood warnings and awareness raising, land use control, home owner adaptation and emergency management. A case study of the Lower Thames catchment illustrates the challenges facing decision-makers in ‘real life’: how those strategies which appear to be most technically and economically effective fall far short of being fair from either a vulnerability or equality perspective. The paper concludes that if we are to manage flood risk somewhat more fairly then a move in the direction of government funding of nationally consistent non-structural strategies, in conjunction with lower investment decision thresholds for other local-level FRM options, appears to offer a greater contribution to equality and vulnerability-based social justice principles than the status quo. [ABSTRACT FROM AUTHOR]

Provides information on a selection of papers presented at the sixteenth Research Conference on Subjective Probability, Utility and Decision Making held in Leeds, England on April 18-21, 1997. Effects of anticipated regret in decision making under uncertainty; Evaluation of policy scenarios for metropolitan traffic in the next decades; Role of frequentistic information in judgments of risk and probability; Hypotheses about how the way in which people represent hypotheses affects the subjective probability people associate with them.

In this paper, we examine how space is integral to the practices and politics of restructuring health and care systems and services and specifically how ideas of assemblage can help understand the remaking of a region. We illustrate our arguments by focusing on health and social care devolution in Greater Manchester, England. Emphasising the open‐ended political construction of the region, we consider the work of assembling different actors, organisations, policies and resources into a new territorial formation that provisionally holds together without becoming a fixed totality. We highlight how the governing of health and care is shaped through the interplay of local, regional and national actors and organisations coexisting, jostling and forging uneasy alliances. Our goal is to show that national agendas continued to be firmly embedded within the regional project, not least the politics of austerity. Yet through keeping the region together as if it was an integrated whole and by drawing upon new global policy networks, regional actors strategically reworked national agendas in attempts to leverage and compete for new resources and powers. We set out a research agenda that foregrounds how the political reorganisation of health and care is negotiated and contested across multiple spatial dimensions simultaneously. [ABSTRACT FROM AUTHOR]

Child welfare removals of children are among the most invasive decisions a state can make toward its citizens, and typically it is the courts that make these decisions. These interventions are regularly exposed to criticism. In this paper, we examine if and how care order proceedings could be improved in England, Finland, Norway, and California, USA. We have asked the judiciary decision‐makers about their view on what should be improved. Our findings show that the organization of the proceedings, including time and staff, are identified as issues in all four systems. Furthermore, the preparations by the child welfare agency are also mentioned as an issue, for English, Finnish, and Californian decision‐makers. Very few decision‐makers indicate features related to the individual, situational, and contextual dimensions, which is interesting since this would be expected from organization theory. The strong call for change in the way proceedings are organized indicates a need for modernization as well as better use of available competency from child development experts. The respondents focus on the elements that a decision‐maker has direct experience with and knowledge about, and this is indeed worth noting for policymakers in the four systems. [ABSTRACT FROM AUTHOR]

Focuses on the role of health information professionals in medical practice in England. Indication of the decision-making scenario; Familiarity on appraisal skills, resources and techniques; Knowledge on research methods and designs.

Objectives: To explore the experiences, acceptability and utility of a decision aid for family carers of people with dementia towards the end of life. Methods: We conducted semi‐structured interviews with a sample of family carers enroled into a 6‐month feasibility study in England, sampling to gain a range of experiences and views, based on relationship to person they cared for (e.g., spouse, adult child), age, gender, and self‐reported use of the decision aid during the feasibility study. Interviews were conducted in March 2021–July 2021 and analysed using reflexive thematic analysis. We used COREQ checklist to report our methods and results. Results: Family carers found the decision aid acceptable, describing it as comprehensive, accessible with relevant information and its presentation enabled good engagement. Experiences of the decision aid covered four main themes which demonstrated the perceived acceptability and utility: 1. A source of support and reassurance; 2. Empowering conversations and confidence; 3. Including the person living with dementia; and 4. Breaking down complexity. Conclusions: An aid focussing on decisions about dementia end of life care supported family carers break down complex and emotive decisions, not only with making decisions in the moment but also in future planning. Patient or Public Contribution: Our three Patient and Public Involvement (PPI) members (all former family carers) were crucial throughout the wider study. PPI supported development of the topic guides, supported trialling the topic guide and interview procedures and finally supported the development of themes as part of the analysis. [ABSTRACT FROM AUTHOR]

Poland's accession to the European Union in May 2004 brought many new possibilities and opportunities for Polish migrants to the United Kingdom. However, the focus on individual migrants has underestimated the complex roles of families in migration strategies and decision making. This paper brings together data from two studies of Polish migrants in London. In 2006-2007, we carried out a qualitative study, Recent Polish Migrants in London. That research examined how families may be reconfigured in different ways through migration, for example, transnational networks and splits within families. While the study participants represented varied examples of family reunification, they also revealed the complex decision making processes about leaving, staying, rejoining and returning. In our most recent study, Polish Children in London Primary Schools, we interviewed parents, who had migrated with children, about their experiences and expectations of London schools. This study revealed that the age of children was usually a factor in family migration decision making. There was a common expectation that younger children could easily adapt to a new school and learn English quickly. Drawing on the findings of these two studies, this paper will explore firstly, the variety of family migration strategies and secondly, the factors that inform migrants' decisions to bring their families (especially children) or to leave them back home. Finally, the paper concludes by considering some of the policy implications of our findings. [ABSTRACT FROM AUTHOR]

Following the major riots within England in August 2011, the efficacy of public order police decision making was brought into a sharp focus. None the less, the reform of this mode of policing within the UK was already underway with a strong emphasis upon policing through consent and the need to facilitate peaceful protest through dialogue and communication. This paper reports upon a critical 'test case' for this 'new approach' by analysing the policing of a series of protests against Government policy across 3 days that surrounded a Government party conference in Sheffield, a large city in the north of England. This paper draws out lessons to be learned from what proved to be a highly successful dialogue-based approach to policing protests. We contend that dialogue and liaison were effective because they allowed for an ongoing dynamic risk assessment that improved command-level decision making and enhanced police proportionality. The subsequent impact upon crowd dynamics allowed for an improved capacity for proactive public order management, encouraged 'self-regulation' in the crowd, and avoided the unnecessary police use of force at moments of tension. The implications of the analysis for theory and practice are discussed. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives This study set out to answer the following questions. What influences a junior doctor’s response to a judgement call within a clinical setting? What, if any, are the relationships between these influences? Methods This paper describes an interpretivist study based on a grounded theory approach to data analysis. This involved a phased approach to data collection using semi-structured interviews. Analysis was facilitated by observations and group presentations. Participants were doctors in their first year of postgraduate practice who were purposively selected from a range of hospitals in the Northern Deanery. Results The data demonstrated a number of influences on whether junior doctors chose to seek senior assistance. These included the upholding and balancing of tenets that were necessary for ensuring safe practice, and estimating the chance and severity of potential negative consequences to patients, themselves and their teams. In order to make these judgements, junior doctors drew on different forms of knowledge, especially knowledge gained from previous clinical experiences. In judging whether or not to contact a senior, pre-registration house officers (PRHOs) were practising essential clinical attributes, that of independent yet co-operative and discerning practitioners who are able to balance multiple considerations while ensuring patient care. Conclusions This particular judgement of risk, as it was described by those interviewed, was a dynamic process exemplified by the need to create counterbalances between multiple consequences. As a result, no prescriptive action could have allowed PRHOs to deal with the numerous configurations they faced and took into account. [ABSTRACT FROM AUTHOR]

This article examines the relationship between social exclusion and bus provision in England in a marketized environment, and outlines the complexities of involving the socially excluded in local transport decision making. An analysis of five case studies, including histories of where requests were made for changes to bus provision, reveals the challenges for voice and responsiveness within a deregulated environment. Local government has limited ability to respond effectively to the socially excluded; bus providers are able to cut or revise services as they wish, and the discourse employed by them emphasizes costs and efficiency rather than social needs. The paper concludes by advocating a more proactive approach toward tackling departmentalism and social exclusion, with more rigorous and focused engagement of those who have difficulty in making their voices heard. At the same time, it recommends the revision of accounting procedures and incentive structures in order to constrain the ability of bus operators to ‘play the system’. [ABSTRACT FROM AUTHOR]

This is the second of two papers reporting on a descriptive mixed methods study of community forensic mental health nurses' experiences of restriction orders and supervised discharge mechanisms. Forensic community mental health nurses (FCMHNs) have a body of experience of working with mentally disordered offenders in the community. A number of these patients will be subject to conditions on discharge. This in effect acts as compulsory community treatment with the sanction of recall to hospital. This paper examines nurses' perceptions of team-working, legal powers and their effects upon compliance. Findings include that FCMHNs express general satisfaction with their input to decision-making but some concerns were raised that challenge the ethic of team-working. Respondents were broadly in favour of increased professional responsibility, although this may be related to a quest for status. A pragmatic if equivocal support for the use of compulsion in community mental healthcare was also expressed. [ABSTRACT FROM AUTHOR]

This paper compares how frontline staff in four national child welfare systems and policy contexts - Finland, Norway, England and the USA (specifically, California) - respond to questions about a scenario of possible harm to children. The countries have different child welfare systems that we anticipated would be reflected in the workers' responses ( n = 1027). The analysis shows differences and similarities between the systems, although often not in line with system expectations. There is also variation within the country samples. The study shows the complex interactions of individual and agency characteristics in addition to the role of proceduralised decision-making systems and professional discretion. Key Practitioner Messages Professional discretion differs., Proceduralised and high threshold systems result in less variation between workers' responses., System categories do not seem to capture the nuances of frontline decision-making. [ABSTRACT FROM AUTHOR]

This paper examines how child welfare workers in England, Norway and the USA (California) perceive children's participation building on 91 qualitative interviews. First, analysing the data using Hart's ladder of children's participation, we found that all Norwegian workers perceived children's participation as some form of decision‐making, whereas 40% of English and 35% of US workers embraced views of children's participation that can be considered token or non‐participation. Second, we coded the data for main themes and found that child welfare workers in all three countries perceived children's participation as hearing the child's opinion and information gathering. The themes of age, maturity and ability to form an opinion also emerged from the data. English workers' reflections about children's participation were more nuanced than their Norwegian and US counterparts; and US workers understood children's participation as children providing valuable information during the investigation of a case more frequently than workers in England and Norway. We discuss the implications of these findings on future research. [ABSTRACT FROM AUTHOR]

The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: 'making recommendations' and 'providing options'. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. 'Making recommendations' led to misalignment and reduced opportunities for questions and collaboration; 'providing options' led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance. A Virtual Abstract of this paper can be accessed at: [ABSTRACT FROM AUTHOR]

Focuses on the White Paper on local government reform in England. Need to bring local government closer to those it served by locating decision-making at district level wherever practicable; Support of the National Executive Committee of the Labour Party on the proposed introduction of regional government; Demand of the nature of the problems in local government for a response that recognizes the limitations of organizational restructuring.

Background: This article is about interactions that occur when someone with intellectual disabilities is engaged in everyday activities with a personal assistant (PA) or a support worker. Method: We examine the detail of nine hours of naturally occurring video‐recorded interactions, to explore how "relational autonomy" is done in practice. Nine people with ID and seven staff took part in the research, which took place in England from 2016–17. Results: We selected six extracts to illustrate different types of joint decision‐making. Informed by inclusive research with a drama group of people with intellectual disabilities, we focus on the ways in which (a) future plans are discussed; (b) choices are offered during an activity; (c) people reflect on their decisions. Conclusion: The article concludes with discussion about the teaching and learning content of choice‐making, on relational autonomy, and the practice learning for PAs, support workers and for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether less invasive methods of autopsy would be acceptable to bereaved parents and likely to increase uptake.Design: Mixed methods study.Setting: Bereaved parents recruited prospectively across seven hospitals in England and retrospectively through four parent support organisations.Sample: Eight hundred and fifty-nine surveys and 20 interviews with bereaved parents.Methods: Cross-sectional survey and qualitative semi-structured telephone interviews.Main Outcome Measures: Likely uptake, preferences, factors impacting decision-making, views on different autopsy methods.Results: Overall, 90.5% of participants indicated that they would consent to some form of less invasive autopsy [either minimally invasive autopsy (MIA), non-invasive autopsy (NIA) or both]; 53.8% would consent to standard autopsy, 74.3% to MIA and 77.3% to NIA. Regarding parental preferences, 45.5% preferred MIA, 30.8% preferred NIA and 14.3% preferred standard autopsy. Participants who indicated they would decline standard autopsy but would consent to a less invasive option were significantly more likely to have a lower educational level (odds ratio 0.49; 95% CI 0.35-0.70; P = 0.000062). Qualitative findings suggest that parents value NIA because of the lack of any incision and MIA is considered a good compromise as it enables tissue sampling while easing the parental burden associated with consenting to standard autopsy.Conclusion: Less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. Further health economic, validation and implementation studies are now required to assess the viability of offering these in routine widespread clinical care.Tweetable Abstract: Mixed methods UK study finds less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper reports on participatory processes using agent-based simulation models which were employed in the New Forest National Park, UK, to facilitate greater appreciation of recreational impact on wildlife and in turn support proposed revisions in management. The models helped to foster a greater understanding of the need for visitor management, but some stakeholders seemed intent on discrediting them and opposing any changes to recreational management. The inherent complexity and lack of user-friendly application of the models meant that use of them was compromised. Opportunities should be sought to increase stakeholder involvement in the long-term collection of data and validation of models, and to embed participatory processes in existing decision-making institutions. Overall, the decision support tools detracted attention from opportunities for researching social learning: tools need to be part of a well-run deliberative learning process that addresses stakeholder representation and power relationships, knowledge validation, social learning and improved transparency. Copyright © 2011 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

Assessment of sustainable development normally takes place within what can best be termed 'administrative' spaces (cities, regions, nation states etc.), where there is some managerial and policy control. Thus recommendations may be derived from an analysis of this space, for example the derivation of indicators and indices, which can feed more readily into decision-making. They are alternatives to the use of defined 'administrative' spaces such as the ecosystem and landscape. The paper questions the viability of landscape as a viable spatial matrix for assessment of sustainability. Joint Character Areas (JCAs) in England were employed as the landscape space, and data were collected to assess environmental quality (via the creation of a Countryside Quality Index, CQI) and social deprivation (via the Townsend Index of Deprivation, TID) for each JCA, as these represent two dimensions of sustainability. Results suggest that when employing JCAs as the spatial matrix it is possible to derive a statistically significant regression between CQI as the independent variable as TDI as the dependent variable. Therefore landscape does have some viability as a space for assessing sustainability. Copyright © 2009 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

Overview and Scrutiny Committees were introduced in England and Wales in the Local Government Act 2000 that ended the role the full council and its committees as the locus of decision-making for most local authorities. Overview and scrutiny committees composed of councillors not on small decision-making executives were tasked with holding these to account. The performance of scrutiny committees is variable. Generally they work best where they concentrate on reviews of policy and practice, with recommendations following from well-researched reports. The paper reviews the difficulties which arise when scrutiny committees endeavour to hold powerful executives to account, and suggests that to strengthen this new legislation is required, in particular to institutionalise scrutiny committees as agencies of the full council, the representative body for the area, comparable to the way in which the select committees at Westminster are the agencies of the Parliament. [ABSTRACT FROM AUTHOR]

This paper considers several of the key findings of the State of the Nation research. Specific reference is made to three areas - impact evaluation, strategic leadership of professional development, and barriers and constraints to effective CPD practice - which are considered with reference to findings from the other TDA-funded projects conducted at about the same time. [ABSTRACT FROM AUTHOR]

This paper focuses on an English case study example of decision making on development and flood risk. It was carried out through qualitative document analysis and 13 in-depth interviews with flood risk professionals and others in the Lower Thames Valley. It illustrates the recent shift in policy in England from flood defence to a flood risk management approach with an increased emphasis on spatial planning and development control. It shows that decision makers take time to come to terms with new government policy. Despite the more prescriptive government guidance on development and flood risk in Planning Policy Guidance 25 and later documents, there remains scope for disagreements, for example, over what constitutes 'safe' development in flood risk areas. Other sustainability objectives can still weigh heavily against flood risk in local decision making. The potential contributions of modelling, and new visualisation techniques in the flood risk management and planning context are considered. [ABSTRACT FROM AUTHOR]

This paper presents a qualitative study exploring the influences that drive clinical decision making among a small group of junior rheumatology nurses. A qualitative, descriptive design was chosen. Semi-structured interviews were used with a purposive sample of six junior staff nurses from two inpatient rheumatology wards in a large teaching hospital in the North of England. The interviews were audiotaped and transcribed using Burnard's (1991) thematic content analysis. The findings demonstrate four distinct themes which influence clinical decision making including professional development, patient-focused care, working in a specialty and rheumatology nursing. Development of experiential knowledge alongside access to specialized information and expert practitioners was also influential in informing decisions. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

involving the public in decision-making has become a bureaucratic pre-occupation for every health agency in the UK. In this paper we offer an innovative approach for local participation in health decision-making through the development of a `grounded' citizens' jury. We describe the process of one such jury commissioned by a Primary Care Group in the north-west of England, which was located in an area suffering intractable health inequalities. Twelve local people aged between 17 and 70 were recruited to come together for a week to hear evidence, ask questions and debate what they felt would improve the health and well-being of people living in the area. The jury process acted effectively as a grass-roots health needs assessment and amongst other outcomes, resulted in the setting up of a community health centre run by a board consisting of members of the community (including two jurors) together with local agencies. The methodology described here contrasts with that practiced by what we term `the consultation industry', which is primarily interested in the use of fixed models to generate the public view as a standardized output, a product, developed to serve the needs of an established policy process, with little interest in effecting change. We outline four principles underpinning our approach: deliberation, integration, sustainability and accountability. We argue that citizens' juries and other consultation initiatives need to be reclaimed from that which merely serves the policy process and become `grounded', a tool for activism, in which local people are agents in the development of policies affecting their lives. [ABSTRACT FROM AUTHOR]

This paper examines the different ways in which the participatory principles of Agenda 21 are being put into practice in the UK, by reference to research in three 'progressive' localities: Kirklees, Leicester and Mendip. The investigation includes an examination of the reasons why a participatory approach is being adopted, how the local authorities are engaging the public in Local Agenda 21 (the levels, methods and scope of participation) and how effective their approaches have been. The research reveals that a variety of participatory methods and techniques are being employed at various scales. The three authorities emphasize a listening and open approach to the decision-making process, but despite their commitment to participation there had been limited success in securing widespread involvement of people, and especially disadvantaged groups, in the process. Key issues to emerge are the importance of the commitment of key elected representatives and the need for participation to be an ongoing commitment with a preparedness to begin with 'where people are at' rather than to set aspirations too high. The implications are that change is needed in the way local authorities relate to the communities they serve, but this will place considerable demands on already stretched local authority resources, particularly where positive action is needed to 'build capacity'. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the factors that influence how social workers make decisions and develop their decision‐making skills in care proceedings, and to identify effective support and intervention to develop social worker decision‐making skills. The study employed a mixed thematic approach across two phases of study: an initial inductive thematic analysis of responses to an online qualitative questionnaire and then a mixed thematic analysis of follow‐up focus groups and interviews with social workers working in various social work roles within England and Northern Ireland. The findings identified a number of themes that help to understand the decision‐making skills of social workers; thorough assessment skills, relationship‐based anti‐oppressive practice, being mindful of the lived experience of the child and using critical reflection to make complex decisions. Wider structural factors that support or hinder decision‐making, particularly in respect of organizational support and management supervision were also identified. Social workers can be supported to develop decision‐making skills through additional training, reflective learning and management support to develop their practice wisdom within this field. [ABSTRACT FROM AUTHOR]

Introduction: Using co‐design processes, we aimed to develop an evidence‐based decision guide for family carers and hospital professionals to support decision‐making about eating and drinking for hospital patients with severe dementia. Methods: Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co‐design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co‐design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide. Results: Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision‐making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co‐design groups developed the aims of the decision guide to support conversations and shared decision‐making processes in acute hospitals, and help people reach evidence‐based decisions. It was designed to clarify decision‐making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person‐centred care, best‐interests decision‐making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England. Conclusion: We used rigorous and transparent processes to co‐design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real‐world impacts. Patient or Public Contribution: People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co‐design workshops. PPI members helped design study procedures and materials and prepare this manuscript. [ABSTRACT FROM AUTHOR]

This study explores how pharmacists legitimise the expansion of their clinical work and considers its impact on pharmacists' professional identity work. In the context of pharmacy in the English NHS, there has been an ongoing policy shift towards pharmacists moving away from 'medicines supply' to patient‐facing, clinical work since the 1950s. Pharmacists are continuously engaging in 'identity work' and 'boundary work' to reflect the expansion of their work, which has led to the argument that pharmacists lack a clear professional identity. Drawing insights from linguistics and specifically Van Leeuwen's 'grammar of legitimation', this study explains how the Pharmacy Integration Fund, a nationally funded learning programme, provides the discursive strategies for pharmacists to legitimise their identity work as clinicians. [ABSTRACT FROM AUTHOR]

Women with learning disabilities are less likely to breastfeed than other women. They may find it hard to understand or learn feeding techniques or know that they have infant feeding choices. This population may be supported during their pregnancies by a range of professionals with differing priorities and responsibilities towards both the mother and the baby. This puts considerable pressure on health care professionals including, but not limited to, midwives, infant feeding specialists, health visitors and learning disability nurses. Those who support women with learning disabilities through their journey into motherhood have a responsibility to ensure the women in their care have the information they need to make decisions about a range of issues, including infant feeding. In the absence of dedicated lactation consultants, this is one of many issues to be discussed within time‐limited appointments. Little is known about the experience of supporting women with learning disabilities to make infant feeding decisions from the point of view of health professionals. Using a qualitative descriptive research design, we conducted online, semistructured interviews with seven UK health professionals about their experience of supporting women with learning disabilities in infant feeding. Thematic analysis identified three themes: the importance of health professionals' having unconditional, positive regard; the need for an individualised approach to supporting women to make infant‐feeding decisions; and being part of the support network. This suggests that women with learning disabilities can make and put into practice infant feeding decisions if they have access to the right support at the right time. Key messages: With the right support at the right time, women with learning disabilities can make infant feeding decisions and successfully feed their babies.Infant feeding options should be discussed early in the pregnancy, with repetition and the use of accessible resources such as videos to support decision‐making.Breastfeeding should be considered a viable option for all women.Health professionals need to be flexible in their approach to supporting infant feeding decision‐making, working as part of the woman's circle of support.Accessible resources can be helpful in supporting infant feeding decision‐making, but one size does not fit all. [ABSTRACT FROM AUTHOR]

Rape offences in England and Wales garner incredibly low levels of convictions. The policing stage of a complaint experiences high levels of case discontinuances. The aim of this research is to explore police officer's decision making in rape cases and how that shapes the attrition of cases. The method employed in this study is qualitative interviews, with retired or serving police officers, with the use of vignettes. This study found that police officers prioritise and continue with cases that they predict to be most likely to reach a conviction. Such predictions are guided by assessments over the strength of the evidence in cases, informed by a range of legal and extra‐legal factors. An overarching prediction employed is how likely a jury would be to convict a case. However, the participants reported that they find it incredibly difficult to accurately predict jury verdicts, making such decisions premised on a flawed logic. [ABSTRACT FROM AUTHOR]

Objective: Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results, these aims may not be fulfilled. Shared decision‐making is widely advocated; yet, most research focusses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore communication and decision‐making around diagnostic blood tests in primary care. Methods: Qualitative interviews were undertaken with patients and clinicians in UK primary care. Patients were interviewed at the time of blood testing, with a follow‐up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians' and patients' expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding. Results: A total of 80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision‐making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing that they were protecting patients from anxiety. Conclusion: Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not have sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision‐making led to downstream consequences when test results did not fulfil patients' expectations. Although shared decision‐making is recommended as best practice, it does not reflect the reality of doctors' and patients' accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis. Patient or Public Contribution: A patient and public involvement group comprising five participants with lived experience of blood testing in primary care met regularly during the study. They contributed to the development of the research objectives, planning recruitment methods, reviewing patient information leaflets and topic guides and also contributed to discussion of emerging themes at an early stage in the analysis process. [ABSTRACT FROM AUTHOR]

Objectives: To assess the cost‐effectiveness of the WISDOM self‐management intervention for type 2 diabetes compared with care as usual. Design: We performed a difference‐in‐differences analysis to estimate differences in risk factors for diabetes complications between people in the WISDOM group (n = 25, 276) and a control group (n = 15, 272) using GP records. A decision analytic model was then used to extrapolate differences in risk factors into costs and outcomes in the long term. Setting: Participating GP practices in West Hampshire and Southampton, UK. Participants: All people diagnosed with type 2 diabetes between January 1990 and March 2020 (n = 40,548). Outcomes Diabetes‐related complications, quality‐adjusted life years (QALYs) and costs to the English National Health Service at 5 years and lifetime. Interventions: The WISDOM intervention included risk stratification, self‐management education programme to professionals and people with type 2 diabetes, and monitoring of key treatment targets. Results: WISDOM was associated with less atrial fibrillation [p = 0.001], albuminuria [p = 0.002] and blood pressure [p = 0.098]. Among all people in the intervention group, WISDOM led to 51 [95%CI: 25; 76] QALYs gained and saved £278,036 [95%CI: −631,900; 176,392] in the first 5 years after its implementation compared with care as usual. During those people' lifetime, WISDOM led to 253 [95%CI: 75; 404] QALYs gained and cost saving of £126,380 [95%CI: −1,466,008; 1,339,628]. The gains in QALYs were a result of reduced diabetes‐related complications through improved management of the associated risk factors. Conclusions: The WISDOM risk‐stratification and education intervention for type 2 diabetes appear to be cost‐effective compared to usual care by reducing diabetes complications. [ABSTRACT FROM AUTHOR]

Background and Aims: In 2003, the UK government passed the Licensing Act for England and Wales. The Act provides a framework for regulating alcohol sale, including four licensing objectives with local governments having devolved responsibility for granting licences to sell alcohol. Members of the public can make representations of oppositions to licence applications. Applying the theories of the policy process, we explored the practices employed by licensing authorities when deciding on alcohol licences in situations of conflict between licence applicants and members of the public. Design Qualitative study comprising a framework analysis of in‐depth semi‐structured interviews and application of the theories of institutionalism, the advocacy coalition framework and role of ideas. Setting: Eleven local authorities in five regions in England in 2019. Participants: Purposive sample of 15 licensing officers, licensing subcommittee chairs, public health leads for licensing and police licensing officers. Measurements The interview schedule included mechanisms of public involvement in licensing, parties involved, the subject of conflicts and how licensing authorities made decisions. Findings When members of the public opposed licence applications, licensing authorities employed three key decision‐making practices: procedural fairness, partnership working and framing. The normativity of procedural fairness was an important institutional structure within which conflicts were resolved. Licensing authorities also worked in partnership with the involved parties, who often appeared as advocacy coalitions that shared beliefs and advanced specific issues to determine mutually acceptable solutions. At times, licensing authorities framed issues through ideational processes to solve problems. Conclusion: Licensing decision‐making under the United Kingdom's Licensing Act for England and Wales appear in many cases to focus on resolution of conflicts between licence applicants and members of the public rather than on promotion of licensing objectives. This raises uncertainty regarding the impact of public involvement on reducing alcohol availability, but ultimately represents a pragmatic process that seeks to restore balance in powers, improve transparency in decision‐making and empower communities. [ABSTRACT FROM AUTHOR]

Public domain decisions in rural England have become more complex as the number of stakeholders having a say in them has increased. Transactions costs can be used to explore this increasing complexity. The size and distribution of these costs are higher in rural areas. Grouping transactions costs into four - organizations, belief systems, knowledge and information, and institutions - two of the latter are evaluated empirically: growth in the bid culture, and monitoring and evaluation. Amongst 65 Agents of Rural Governance (ARGs) in Gloucestershire, both were found to be increasing over time, but those relating to finance were a greater burden than those of monitoring: the latter can improve ARG performance. Increasing transactions costs in rural decision-making appears to be at variance with ambitions of achieving 'smaller government' through, for example, the Big Society. Smaller government is likely to be shifting the incidence of these costs, rather than reducing them. [ABSTRACT FROM AUTHOR]

Both nonstatutory community-based catchment management groups and existing statutory groups seek effective environmental management characterised by public participation, collaborative working and decentralised modes of assessment, planning and decision making. The characteristics and challenges of catchment management for water resources and protection of water quality require such approaches, and an expansion of both community-based and state-led initiatives has been evident in the United Kingdom. Available information about these developments is, however, limited and this paper reports survey findings of such initiatives, providing a mid-to-late 2009 'snapshot' of the situation in England and Wales. Catchment management groups are profiled in terms of size, organisational structure, membership, financing, technology transfer, policy influence and other outcomes. The results are interpreted with reference to a growing international literature, the potential sustainability, effectiveness and impact of groups and environmental governance challenges, including those posed by the European Union Water Framework Directive. [ABSTRACT FROM AUTHOR]

An outbreak of foot-and-mouth disease (FMD) occurred in Surrey on August 3, 2007. A Great Britain-wide ban on livestock movements was implemented immediately. This coincided with the start of seasonal sheep movements off the hills in Scotland; the majority of these animals are sold via markets. The ban therefore posed severe economic and animal- welfare hardships if it was to last through September and beyond. The Scottish Government commissioned an analysis to assess the risk of re-opening markets given the uncertainty about whether FMD had entered Scotland. Tracing of livestock moved from within the risk zone in England between July 16 and August 3 identified contact chains to 12 Scottish premises; veterinary field inspections found a further three unrecorded movements. No signs of infection were found on these holdings. Under the conservative assumption that a single unknown Scottish holding was infected with FMD, an estimate of the time-dependent probability of Scotland being FMD free given no detection was made. Analyses indicated that if FMD was not detected by early to mid-September then it was highly probable that Scotland was FMD free. Risk maps were produced to visualise the potential spread of FMD across Scotland if it was to spread either locally or via market sales. [ABSTRACT FROM AUTHOR]

Within the context of rural civic participation, three different types of trust are described, based on Simmelian-related constructs: personal trust, system trust and instrumental trust. Each has two components, a justification and a leap of faith. These vary in proportion according to degrees of knowledge held. Shifts in public domain decision-making have changed the emphasis of different types of trust. In using constructs of social capital to explore rural decision-making, bonding social capital is seen to cohere around notions of personal trust, bridging social capital around system trust and contested social capital around instrumental trust. In rural decision-making it is suggested, drawing from case study evidence in Gloucestershire, that personal trust is becoming increasingly important because of the localisation of decision-making and ambiguities in representation. A greater reliance is also being placed on system trust because of increasingly complex decision-making structures. While in principle instrumental trust can be ameliorated through access to knowledge and information, increasingly, the volume of information is problematic, and decision-makers are relinquishing their knowledge to ‘experts’. [ABSTRACT FROM AUTHOR]