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People with intellectual disabilities face health disparities, including in high‐income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID‐19 pandemic, and the implementation of the Valuing People white paper are discussed. [ABSTRACT FROM AUTHOR]

People with learning disabilities are living longer. Older people with learning disabilities should be included in policies and plans that are for all older people. National plans and policies for older people often do not say anything about older people with learning disabilities, and it is hard to know whether older people with learning disabilities are benefiting. People who plan services locally often do not have good information on older people with learning disabilities. Using the Equalities Act 2010 could help people who plan services and write policy to think about older people with learning disabilities but this is not happening at the moment. People who work with older people with learning disabilities should be aware of policy for all older people, so that older people with learning disabilities do not miss out. This paper seeks to explore the opportunities and challenges generated by current policy, guidance and legislation in England relating to older people, in terms of the practical implications for older people with learning disabilities. Using the broad themes housing, employment, social inclusion and isolation, care and support, and promoting better health and well-being, this paper discusses potential practical opportunities and concerns for older people with learning disabilities arising from policy and legislation such as current initiatives regarding integration, personalisation and the dementia policy. Consideration is given to the implications of changing policy and practice for both current and future generations of people with a learning disability as they reach older age. This discussion paper concludes that whilst there is potential for older people with a learning disability to benefit from policy and practice aimed at improving the lives of older people generally, the tendency for policy to be targeted at specific groups without adequately considering the diversity of those groups often leaves those with a learning disability at the margins of being able to make the most of changes. [ABSTRACT FROM AUTHOR]

Background: Very young children from lower socioeconomic status (SES) backgrounds often show poorer language development. Whilst there have been attempts to provide early intervention programmes, these sometimes miss the most disadvantaged groups. Aims: This report presents preliminary feasibility and effectiveness data for a novel language intervention designed for parents of toddlers in the United Kingdom. Methods and Procedures: In total, 43 UK families of 2–4‐year‐olds were recruited to the study, half of whom completed an 8‐week course (Tots Talking) focussed on parent interaction, and half of whom acted as wait‐list controls. Results and Outcomes: Results suggest that such programmes are feasible for families with 86% staying in the intervention. In addition, greater changes in underlying communication skills such as joint attention and gesture were evident compared to wait‐list controls. Conclusions and Implications: We conclude that pre‐verbal skills may be more important to measure as initial outcomes than language or vocabulary change in this population. What This Paper Adds: What is already known on the subject: Children from lower socioeconomic status (SES) backgrounds are at higher risk of communication difficulties and there is a need for community intervention programmes for very young children. What this study adds: This study suggests that such programmes can be feasible and effective, but that very early/basic communicative skills (such as joint attention) may be boosted first rather than language or vocabulary. What are the clinical implications of this work?: Children's centres and other community services could feasibly run short parent facing courses emphasising contingent communication in low SES families and other diverse groups. These may be more successful run with younger preschoolers. Joint attention may be a better focus of intervention before expecting vocabulary or language change. Community health professionals may find this information useful in referring and supporting families in need. [ABSTRACT FROM AUTHOR]

This article argues that reforms of higher education finance for undergraduates in England introduced by the Blair government in 2006 provided a progressive strategy for achieving the central objectives of higher education of quality (better), access (wider) and size (larger). Reforms in 2012 are a not a strategy but a collection of ad hoc arrangements. They include the good (a higher fees cap, a higher interest rate on student loans, better information and improved support for part-time study), the bad (abolishing most taxpayer support for teaching in the arts and humanities and the social sciences, and raising excessively the threshold at which loan repayments start) and the unspeakable (abolishing Education Maintenance Allowances and AimHigher). The reforms are fiscally costly and hence perpetuate the central problem of capped student numbers, and will not stand the test of time. The concluding section outlines the next White Paper. [ABSTRACT FROM AUTHOR]

Introduction: Co‐production with communities is increasingly seen as best practice that can improve the quality, relevance and effectiveness of research and service delivery. Despite this promising position, there remains uncertainty around definitions of co‐production and how to operationalize it. The current paper describes the development of a co‐production strategy to guide the work of the ActEarly multistakeholder preventative research programme to improve children's health in Bradford and Tower Hamlets, UK. Methods: The strategy used Appreciative Inquiry (AI), an approach following a five‐step iterative process: to define (Step 1) scope and guide progress; to discover (Step 2) key issues through seven focus groups (N = 36) and eight in‐depth interviews with key stakeholders representing community groups, and the voluntary and statutory sectors; to dream (Step 3) best practice through two workshops with AI participants to review findings; to design (Step 4) a co‐production strategy building on AI findings and to deliver (Step 5) the practical guidance in the strategy. Results: Nine principles for how to do co‐production well were identified: power should be shared; embrace a wide range of perspectives and skills; respect and value the lived experience; benefits should be for all involved parties; go to communities and do not expect them to come to you; work flexibly; avoid jargon and ensure availability of the right information; relationships should be built for the long‐term; co‐production activities should be adequately resourced. These principles were based on three underlying values of equality, reciprocity and agency. Conclusion: The empirical insights of the paper highlight the crucial importance of adequate resources and infrastructure to deliver effective co‐production. This documentation of one approach to operationalizing co‐production serves to avert any misappropriations of the term 'co‐production' by listening to service users, stakeholders and other relevant groups, to develop trust and long‐term relationships, and build on the learning that already exists amongst such groups. Patient or Public Contribution: The work was overseen by a steering group (N = 17) of individuals, both professional and members of the public with experience in undertaking co‐production, and/or with some knowledge of the context of the two ActEarly field sites, who provided regular oversight and feedback on the AI process. [ABSTRACT FROM AUTHOR]

As the United Kingdom reduces its CO2 emissions in order to meet its 2050 net zero greenhouse gas targets, there will be a significant evolution of the UK's energy mix. The reliance on hydrocarbons will decrease while there is predicted to be an increase in low carbon energy sources such as renewables and nuclear. In order to decarbonise and achieve the net zero emissions targets while concurrently producing enough energy to provide for national energy needs, large‐scale, low carbon energy generation projects need to be developed alongside energy storage facilities to provide flexibility within a low carbon energy supply. Robust CCUS programmes will need be developed in order to capture and store unavoidable carbon dioxide emissions. The subsurface geology of the UK provides opportunities for the development of low carbon energy generation, energy storage and CCS, and the Upper Permian Zechstein Supergroup deposited in eastern England and offshore in the Southern North Sea is a potential host for these new developments. In NE England, salt cavern gas storage sites have been developed in thick Zechstein evaporites since the mid 20th centrury. In this paper we present new isopach maps and well correlation panels which will help to outline optimal locations for the development of additional salt caverns for gas storage. A review of the Zechstein Supergroup indicates that it does not exhibit great potential for the development of CCS, due both to its complex reservoir characteristics and to difficulties with both subsurface imaging and monitoring. However thick Zechstein evaporites could provide an excellent seal for CO2 storage in the underlying Lower Permian Rotliegend Group. [ABSTRACT FROM AUTHOR]

The Upper Permian Zechstein Supergroup has the potential to play an important role in the UK's future energy production and energy transition. However the Supergroup is comparatively poorly understood in the UK, particularly the link between the onshore and offshore geology. In this paper we re‐evaluate available data in order to present a consistent regional interpretation of the Z1 to Z3 Zechstein Supergroup cycles. This review is based on an interpretation and re‐evaluation of 620 offshore wells located in the UK portion of the SW Southern North Sea and 83 onshore wells located in Yorkshire and Lincolnshire (eastern England). The Zechstein Supergroup was interpreted in each well, and the data was used to compile seven SW‐NE oriented correlation panels which show the development of the Supergroup in the study region. Five isopach maps for key formations in the Zechstein Supergroup were created, together with depositional environment maps for each of the main Zechstein carbonate formations. In combination, these regional‐scale maps and diagrams have resulted in a consistent interpretation of the Zechstein Supergroup over an area which extends from the onshore outcrop in the west to the UKCS boundary in the Southern North Sea in the east. [ABSTRACT FROM AUTHOR]

In England, pupils aged 16 take the General Certificate of Secondary Education (GCSE) examinations for a range of subjects. The current assessment models for GCSE include a two-tier structure for some subjects and a non-tier model for the others. The tiered subjects have a higher tier designed for high achieving pupils and a lower tier for low achieving pupils. The higher tier paper is targeted at grades A*–D (with A* the highest grade available), while the lower tier paper at grades C–G (with G the lowest grade). The UK government has proposed a comprehensive reform of GCSEs. It suggested that, with tiered papers, pupils are forced to choose between higher and lower tier papers, which will place a cap on the ambition of those entering for the lower tier. The government therefore suggests avoiding tiering in the reformed GCSEs when possible. This paper discusses the technical and equity issues with the use of tiered examinations in current GCSEs and reviews potential alternative assessment approaches for effective differentiation between pupils for the reformed GCSEs. [ABSTRACT FROM AUTHOR]

The Equals Formal Curriculum English Scheme of Work has been designed for that very small percentage of the school population, perhaps as low as one or two per cent, who have global learning difficulties (GLD) to such a degree that they are consistently working at levels significantly below their age‐related peers for all of their academic lives. The term GLD includes all those in England currently ascribed as having severe learning difficulties (SLD) and many if not most, currently ascribed as having moderate learning difficulties (MLD). Evidence of the difficulties faced by such pupils will become increasingly obvious beyond Year 1 at age 6, because the difficulties are global rather than specific. That is, they are likely to affect all learning, but will be particularly apparent in numeracy and literacy. This paper, the first of two, seeks to clarify why reading and writing are so extraordinarily difficult for this population and posits that the answers lie in challenging perceived wisdoms within the education system's predilections towards (i) regarding phonics as the only solution to reading difficulties (ii) persisting over time (and in the face of evidence to the contrary) with the view that children, young people and adults with GLD can make sufficient progress within phonics teaching and (iii) the use of differentiation of a standardised national curriculum model as being a sufficient answer to global learning difficulties. Clearly the main language used in England is English, but the principles and ideas outlined in this paper should apply in any language which uses a phonic structure when teaching language. [ABSTRACT FROM AUTHOR]

Introduction: The UK low‐risk drinking guidelines were revised in 2016. Drinkers were primarily informed about the guidelines via news media, but little is known about this coverage. This study investigated the scale and content of print and online textual news media coverage of drinking guidelines in England from February 2014 to October 2017. Methods: We searched the Nexis database and two leading broadcasters' websites (BBC and Sky) for articles mentioning the guidelines. We randomly selected 500 articles to code for reporting date, accuracy, tone, context and purpose of mentioning the guidelines, and among these, thematically analysed 200 randomly selected articles. Results: Articles mentioned the guidelines regularly. Reporting peaked when the guidelines revision was announced (7.4% of articles). The most common type of mention was within health‐ or alcohol‐related articles and neutral in tone (70.8%). The second most common was in articles discussing the guidelines' strengths and weaknesses, which were typically negative (14.8%). Critics discredited the guidelines' scientific basis by highlighting conflicting evidence and arguing that guideline developers acted politically. They also questioned the ethics of limiting personal autonomy to improve public health. Criticisms were partially facilitated by announcing the guidelines alongside a 'no safe level of drinking' message, and wider discourse misrepresenting the guidelines as rules, and highlighting apparent inconsistencies with standalone scientific papers and international guidelines. Discussion and Conclusions: News media generally covered drinking guidelines in a neutral and accurate manner, but in‐depth coverage was often negative and sought to discredit the guidelines using scientific and ethical arguments. [ABSTRACT FROM AUTHOR]

Figures are showing that ethno‐cultural issues are increasingly related to most school bullying incidents happening lately. While many theoretical arguments and empirical investigations scrutinize the effects of foreign migration on hostile behaviors enacted by the adult population, there is insufficient evidence on the effects of immigration on youth. This paper provides evidence by exploiting the shock from migration that occurred in the UK after the 2004 European Union Enlargement to estimate the magnitude and the directionality of the effect exerted by the resulting inflow of migrants on school bullying. Multilevel logit, generalized estimating equations, and control function with two‐stage residual inclusion are used on a novel data set containing spatially fine‐grained observations on school bullying across the UK. Findings highlight a relevant effect of the shock from migration in triggering bullying, which is robust to the accounting for potential endogeneity with respect to immigrants' location choice. The role of existing language barriers as a channel for the effect of the migration shock is also scrutinized, to find that they increase its effect. [ABSTRACT FROM AUTHOR]

This article examines the spaces, materiality, and practices of (in)formal education and citizenship bound up in the educational cultures of the Council for the Preservation of Rural England (CPRE) in 1930s England. Founded in 1926, the CPRE aimed to preserve rural amenities through concerted action, by working through their constituent societies as a centre for furnishing or obtaining advice and information, and importantly, by educating public opinion. While much work has examined inter‐war preservationism and the CPRE's focus on planning legislation and design, less attention has been paid to the CPRE's cultures of education for children and young people. Drawing on archival research, this paper considers two educational topics, namely, nature study and school design, and makes three key contributions to the geographies of education. First, that the CPRE mobilised the notion of amenity to provide an experiential and intuitive education in preservationism: amenity was both education and educator. Second, that this education was linked to notions of (future) citizenship, hope, and (future) preservationism, becoming an education that would remain with the child throughout their life. Third, this article explores the CPRE's authority, revealing the ways in which it was often complex and precarious, as well as the ways in which the Council drew on other forms of authoritative identities, spaces, and structures. In so doing, this paper contributes to ongoing academic debates on the complex and fluid boundaries of (in)formal education. [ABSTRACT FROM AUTHOR]

This paper reports research commissioned by an English City Council. Its aim was to gather data to identify and prioritise the council's efforts to develop, co‐ordinate and monitor services and support for young people with SEND in the city as they move into their adult lives. This included the four areas identified by the English government in the SEND Code of Practice, these being: employment, community inclusion, health and independent living. The study used qualitative and quantitative research methods including semi‐structured interviews and questionnaires to investigate the experiences of students, teachers, National Health Service staff and social workers in identifying processes and structures that support or hinder the transition process as children prepare for adulthood. As such the study gathered generic data to indicate the expectations, needs, aspirations and views of young persons between the ages of 14 and 22 with regards to employment, education, community inclusion and health. An interpretation of data from the research illustrated the effectiveness of the support structures that are in place to help with planning and delivery of the strategic direction for services supporting children and young people with SEND as they become adults. [ABSTRACT FROM AUTHOR]

Although breastfeeding is known to improve health, economic and environmental outcomes, breastfeeding initiation and continuation rates are low in the United Kingdom. The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) aims to reverse declining rates of breastfeeding by shifting the culture of infant feeding care provision throughout hospital maternity settings. In the United Kingdom, the global BFHI has been adapted by UNICEF UK reflecting a paradigm shift towards the experiences of women and families using maternity services. This research used a critical ethnographic approach to explore the influence of the national UNICEF UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. Twenty‐one staff and 26 service users were recruited and engaged in moderate‐level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. Using Antonovsky's sense of coherence construct, the findings discussed in this paper highlight how the BFI offers 'informational' (comprehensible), 'practical' (manageable) and 'emotional' (meaningful) support for both staff and service users, strengthened by effective, local leadership and a team approach. This is juxtaposed against the tensions and demands of the busy hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish. [ABSTRACT FROM AUTHOR]

Accessible Summary: This paper shows what people with learning disabilities can get out of enjoying books and reading even when they cannot read words easily.The writers think about how people with learning disabilities can be helped to enjoy books. They say that this can happen through reading with other people, enjoying lots of activities about books and making books part of their daily routine.The writers also think about the way that books and stories help us to learn about the world and the people in it.The writers are annoyed about the way that enjoyment of books by people with learning disabilities has been ignored by people.This matters to people with learning difficulties because enjoying books, even when we cannot read words easily, can give us good feelings and help us to learn and develop. This paper presents the findings of an original research project commissioned by BookTrust, a respected UK charity that gifts books to children, young people (CYP) and their families. It explored the impact and modus of pleasurable engagement with books among CYP with severe and profound learning disabilities and applied a critical, phenomenological stance on what it means to read through drawing on "inclusive literacy" as a conceptual framework. Data were collected from four local areas in England and included 43 CYP aged 4–14. In keeping with a phenomenological stance, it employed interpretivist methods involving 13 deep‐level interviews with families to include observations and structured play; 13 observations of CYP sharing books with others in home, play or school settings, and interviews with 27 practitioners working in a range of organisations (e.g., Portage service and advisory teams). Findings were that books had a positive impact on well‐being, social inclusion and development. CYP were engaged in enjoying the content of books through personalisation, sensory stimulation, social stimulation and repetition. This affirmed the theoretical and practical approaches espoused by "inclusive literacy" but made a critical and original contribution to our understanding of the special place that books occupy as ordinary artefacts of literary citizenship among this cohort. The benefits of volitional reading among CYP who do not have learning disabilities are well known, but the authors urge publishers and policymakers to recognise CYP with severe and profound learning disabilities as equally important, active consumers of books who have much to gain from reading for pleasure. [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]

This TACTYC funded research highlights the role that Maintained Nursery Schools (MNS) play in supporting families within areas of extreme social deprivation in the UK. Data collected through survey and interview demonstrated the positive impact that these schools have upon disadvantaged children and their families, providing a breadth and depth of ongoing care, against a backdrop of ongoing fiscal cuts and uncertainty. Often this provision was in lieu of the reported minimisation of other social services support for struggling families. We argue in this paper that the loss of these state institutions could be highly detrimental to the families that they currently support. [ABSTRACT FROM AUTHOR]

Background and Aims: Youth alcohol consumption has declined significantly during the past 15 years in many high‐income countries, which may have significant public health benefits. However, if the reductions in drinking occur mainly among lighter drinkers who are at lower risk, then rates of alcohol‐related harm among young people today and adults in future may not fall in line with consumption. There is conflicting evidence from Swedish school studies, with some suggesting that all young people are drinking less, while others suggest that alcohol consumption among heavier drinkers may be stable or rising while average consumption declines. This paper extends the geographical focus of previous research and examines whether the decline in youth drinking is consistent across the consumption distribution in England. Design Quantile regression of 15 waves of repeat cross‐sectional survey data. Setting: England, 2001–16. Participants: A total of 31 882 schoolchildren (50.7% male) aged 11–15 who responded to the Smoking Drinking and Drug Use among Young People surveys. Measurements Past‐week alcohol consumption in UK units at each fifth percentile of the consumption distribution. Findings Reductions in alcohol consumption occurred at all percentiles of the consumption distribution analysed between 2001 and 2016, but the magnitude of the decline differed across percentiles. The decline in consumption at the 90th percentile [β = −0.21, confidence interval (CI) = −0.24, −0.18] was significantly larger than among either lighter drinkers at the 50th percentile (β = −0.02, CI = −0.02, −0.01) or heavier drinkers at the 95th percentile (β = −0.16, CI = −0.18, −0.13). Conclusions: Alcohol consumption among young people in England appears to be declining across the consumption distribution, and peaks among heavy drinkers. The magnitude of this decline differs significantly between percentiles of the consumption distribution, with consumption falling proportionally less among the lightest, moderate and very heaviest youth drinkers. [ABSTRACT FROM AUTHOR]

The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that children and young people with neurological conditions who missed outpatient appointments have more emergency inpatient admissions and Accident and Emergency centre (A&E) visits than those who missed none.Method: Retrospective cohort of individuals aged up to 19 years with neurological conditions, identified from routine hospital data in England, UK from April 1st, 2003 to March 31st, 2015 using an International Statistical Classification of Diseases and Related Health Problems, coding framework. Counts of emergency inpatient admissions and A&E visits per person per year were modelled (random intercept negative binomial regression) with outpatient attendance the independent variable of interest.Results: The cohort numbered 524 613 individuals. Those who missed outpatient appointments had 19 per cent (95% confidence interval [CI] 18-19) more emergency inpatient admissions and 16 per cent (95% CI 15-17) more A&E visits per year than those who missed none. 'Did not attends' had a larger increase in unplanned health care than patient or provider cancellations. If no appointments were missed, the models predict there would have been 107 000 fewer A&E visits from 2007/2008 to 2014/2015 and 104 000 fewer emergency inpatient admissions from 2003/2004 to 2014/2015.Interpretation: Missed outpatient appointments were associated with increased unplanned health care. Improving outpatient attendance may have the potential to reduce emergency inpatient admissions and A&E visits.What This Paper Adds: Missed outpatient appointments by children and young people with neurological conditions are associated with increased unplanned health care. Both emergency inpatient admissions and Accident and Emergency centre visits are increased. 'Did not attends' are more strongly associated with unplanned health care than cancellations. [ABSTRACT FROM AUTHOR]

This paper considers how literary and cinematic constructions of Essex noir expose the darker, chaotic sides to working-class embourgeoisement: initially via post-War suburbanisation and later, via Margaret Thatcher's attempt to encourage competitive individualism and entrepreneurship. Noir angles a 'dark mirror' to suburban Essex and develops a distinctive aesthetics of social and cultural change, while also puncturing myths of social mobility and suburban security. The paper points to both affinities and breaks between noir's bleak pessimism and Walter Benjamin's understanding of history as overcoming the concept of progress. [ABSTRACT FROM AUTHOR]

Aim: To review the existing evidence regarding the use of language in clinical encounters. Background: Awareness of the importance of language in clinical encounters is mostly lacking or located within broader discussions on communication. Methods: A scoping study was conducted to review existing research that could increase our understanding of the role language plays as well as identify gaps in knowledge and inform the development of a position statement on language in diabetes care. Results: Evidence shows that, although carefully chosen language can have a positive effect, there is a potential negative impact of language on people's experiences of diabetes care. The use of stigmatizing and discriminatory words during communication between healthcare practitioners and people with diabetes can lead to disengagement with health services as well as sub‐optimal diabetes self‐management. Clinical encounters can be compromised where language barriers exist or where there is limited understanding of cultural differences that may have an impact on diabetes self‐management. What little empirical evidence there is shows that training can improve language and communication skills. Conclusion: This review raises a number of questions that are being addressed by the NHS England Language Matters Group, which has developed a set of recommendations to support the use of appropriate language in clinical encounters. What's new?: This paper reviews existing evidence regarding the use of language in clinical encounters.Poor language practices can lead to stigma, lack of engagement with self‐management, low satisfaction with care and poor clinical outcomes.Research has demonstrated the importance of good communication skills and that appropriate use of language can benefit psychosocial well‐being and support optimal diabetes self‐management.Our review has directly informed the publication of a UK Position Statement on Language Matters. [ABSTRACT FROM AUTHOR]

This paper explores religious adolescents' reported experiences of secondary schools. Fifty-four qualitative interviews were conducted in places of worship in three cities in England with Christians (n=46), Jews (n=38) and Muslims (n=15). Secondary schools of a religious and non-religious character were reported as not providing a suitable environment for religious observances, nor as a place to act and behave according to participants' religious principles. Religious adolescents reported prejudice and criticism of their beliefs or religious affiliations from their peers and sometimes from teachers. They also perceived their religious traditions to be distorted, inaccurately or unfairly represented in some lessons. The focus of this paper is the identity choices religious adolescents reported in response to these challenges. Three groups of identity choices are theorised and explored: religious identity seeking, religious identity declaration and religious identity masking. The findings are discussed in view of religious identity construction theory, good practice for teachers and also the potential concerns of faith communities. [ABSTRACT FROM AUTHOR]

This paper reports on doctoral research carried out in the UK into the experience of complexity in child protection work. The study explored what complexity meant for practitioners, and examined its significance for interprofessional working. A qualitative, case-based approach was adopted, drawing on the experiences of 17 practitioners working on two separate child protection cases. Participants were from a range of agencies, including children's social care, education, youth offending and child/adolescent mental health. Two rounds of semi-structured interviews were carried out over a period of four months. Interview transcripts were analysed using interpretative phenomenological analysis, a research methodology derived from qualitative psychology. The findings revealed complexity to be a multifaceted phenomenon, driven by the dynamics of cause and effect in open social systems. Practitioners' perception of unpredictability and volatility in these cases fed into various aspects of collaborative work: the experience of relationships, the process of assessment, efforts at intervention and concerns about risk. The paper concludes by exploring some implications for policy and practice in terms of how interprofessional networks are set up to manage the needs of vulnerable children and families. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Messages Complexity makes it hard for practitioners to understand cause and effect, predict outcomes and control the course of events., To manage complexity, the team around the child may need to operate as a strategic unit rather than a collection of tactical interventions., When complex cases become 'stuck', professional networks may need additional support and consultation from specialist agencies., 'Complexity makes it hard for practitioners to understand cause and effect, predict outcomes and control the course of events' [ABSTRACT FROM AUTHOR]

The question of where to locate teaching about the relationships between science and religion has produced a long-running debate. Currently, science and religious education (RE) are statutory subjects in England and are taught in secondary schools by different teachers. This paper reports on an interview study in which 16 teachers gave their perceptions of their roles and responsibilities when teaching topics that bridge science and religion and the extent to which they collaborated with teachers in the other subject areas. We found that in this sample, teachers reported very little collaboration between the curriculum areas. Although the science curriculum makes no mention of religion, all the science teachers said that their approaches to such topics were affected by their recognition that some pupils held religious beliefs. All the RE teachers reported struggling to ensure students know of a range of views about how science and religion relate. The paper concludes with a discussion about implications for curriculum design and teacher training. [ABSTRACT FROM AUTHOR]

This paper explores satisfaction with the political domain of local government performance, using survey data from a contemporary British city as the empirical context. It employs a factor-augmented ordered logit analysis of data emerging from a representative city-wide series of over 1,000 household interviews. Affective reactions to local economic performance and policy effectiveness are constructed in the spirit of the approach used in earlier work by social scientists. The key significant influences that raise or depress satisfaction at this geographical level are presented. Affective reactions to past policy and the economy are both shown to be statistically significant, but with reactions to the economy being negative while those for other policy reactions seemingly positive. [ABSTRACT FROM AUTHOR]

Aims This paper estimates how far monthly changes in prevalence of cigarette smoking, motivation to quit and attempts to stop smoking have been associated with changes in prevalence of high-risk drinking, and motivation and attempts to reduce alcohol consumption in England. Design Data were used from the Alcohol and Smoking Toolkit Studies between April 2014 and June 2016. These involve monthly household face-to-face surveys of representative samples of ~1700 adults in England. Measurements Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling was used to assess the association over time between monthly prevalence of (a) smoking and high-risk drinking; (b) high motivation to quit smoking and high motivation to reduce alcohol consumption; and (c) attempts to quit smoking and attempts to reduce alcohol consumption. Findings Mean smoking prevalence over the study period was 18.6% and high-risk drinking prevalence was 13.0%. A decrease of 1% of the series mean smoking prevalence was associated with a reduction of 0.185% of the mean prevalence of high-risk drinking 2 months later [95% confidence interval (CI) = 0.033 to 0.337, P = 0.017]. A statistically significant association was not found between prevalence of high motivation to quit smoking and high motivation to reduce alcohol consumption (β = 0.324, 95% CI = -0.371 to 1.019, P = 0.360) or prevalence of attempts to quit smoking and attempts to reduce alcohol consumption (β = −0.026, 95% CI = -1.348 to 1.296, P = 0.969). Conclusion Between 2014 and 2016, monthly changes in prevalence of smoking in England were associated positively with prevalence of high-risk drinking. There was no significant association between motivation to stop and motivation to reduce alcohol consumption, or attempts to quit smoking and attempts to reduce alcohol consumption. [ABSTRACT FROM AUTHOR]

In the context of the international problem of 'early school leaving', this paper explores the issue of sustained participation in upper secondary education in England. It focuses in particular on the position of middle attainers, who constitute a large proportion of the cohort and whose progress will be vital in realising the government's goal of 'Raising the Participation Age' to 18 by 2015. The paper draws on evidence from national research undertaken as part of the Nuffield Review of 14-19 Education and Training in England and Wales and analysis of New Labour and Coalition policy between 2000-2012. It uses a three-year local study of 2400 14- and 16-year-olds in an established school/college consortium to illustrate the effects of policy and practice on middle attainers. We argue that this important group of young people was 'half-served' by New Labour, because of its incomplete and contradictory 14-19 reforms, and is now being 'overlooked' by Coalition policy because of its emphasis on high attainers. We conclude by suggesting a range of measures to support the 14+ participation, progression and transition of middle attainers in the English education and training system. [ABSTRACT FROM AUTHOR]

This paper argues that direct control of the early years literacy curriculum recently exercised by politicians in England has made the boundaries between research, policy and practice increasingly fragile. It describes how policy came to focus most effort on the use of synthetic phonics programmes in the early years. It examines why the Clackmannanshire phonics intervention became the study most frequently cited to justify government policy and suggests a phonics research agenda that could more usefully inform teaching. It argues that, whilst academics cannot control how their research is eventually used by policy-makers, learned societies can strengthen their ethics policies to set out clearer ground rules for academic researchers working across knowledge domains and with policy-makers. A stronger framework to guide the ethical interpretation of research evidence in complex education investigations would allow more meaningful conversations to take place within and across research communities, and with research users. The paper suggests some features for such a framework. [ABSTRACT FROM AUTHOR]

Since 1992, the UK Government has published so-called 'school league tables' summarising the average General Certificate of Secondary Education ( GCSE) 'attainment' and 'progress' made by pupils in each state-funded secondary school in England. While the headline measure of school attainment has remained the percentage of pupils achieving five or more good GCSEs, the headline measure of school progress has changed from 'value-added' (2002-2005) to 'contextual value-added' (2006-2010) to 'expected progress' (2011-2015) to 'progress 8' (2016-). This paper charts this evolution with a critical eye. First, we describe the headline measures of school progress. Second, we question the Government's justifications for scrapping contextual value-added. Third, we argue that the current expected progress measure suffers from fundamental design flaws. Fourth, we examine the stability of school rankings across contextual value-added and expected progress. Fifth, we discuss the extent to which progress 8 will address the weaknesses of expected progress. We conclude that all these progress measures and school league tables more generally should be viewed with far more scepticism and interpreted far more cautiously than they have often been to date. [ABSTRACT FROM AUTHOR]

In England, as elsewhere, there is a tension in primary schools between imparting knowledge and teaching basic skills like literacy and numeracy. State-mandated programmes are generally concerned with structure and skills. However, a number of ministers and advisers across administrations have sought to expand the explicit teaching of world knowledge (culture, geography and science) as advocated by E. D. Hirsch in the Core Knowledge curriculum. This paper describes an independent evaluation of an adaptation of that approach, called the 'Word and World Reading' programme as used with children aged 7 to 9 in England, to assess its impact on wider literacy. Nine primary schools were randomised to receive the intervention from the start and another eight a year later. The outcomes, assessed by the Progress in English test in literacy after one year, showed no discernible effect overall ('effect' size −0.03), and a small improvement for those eligible for free school meals (+0.06). There was no school dropout, but the missing data for around 18% of 1628 pupils means the results must be treated with some caution. Observations suggest that the lack of clear benefits could be due to the poor quality of implementation in some schools or classes. Perhaps teachers as professionals do not respond well to prescriptive curricula. It is also possible that factual knowledge does not translate directly to improved literacy skills, at least not within one year. Teaching children facts alone in this way cannot be justified solely in terms of improved literacy. Even the scheme on which this intervention was based stressed the need for pupils to learn how to handle facts as well as to learn the facts themselves. [ABSTRACT FROM AUTHOR]

Whether someone has ever had free school meal ( FSM) eligibility over a six-year period is the measure of socio-economic disadvantage currently used in the English school system. It is used to monitor the socio-economic gap in achievement in the education system, to identify particular children at risk of low achievement and to direct funding to particular children and schools. In this paper we assess how well this measure predicts pupil attainment in secondary school in comparison to other measures of socio-economic background known to influence pupil attainment, such as parental education or income. We ask whether the FSM measure is an adequate proxy for a pupil's socio-economic disadvantage in an educational context. To do this we draw on the Longitudinal Study of Young People in England and matched administrative data. We find that the FSM eligibility measure correlates highly with other measures of socio-economic disadvantage, however it does not identify all children living in what would be deemed deprived households. We then compare the extent to which the FSM eligibility measure predicts educational achievement relative to other measures of deprivation and find that its predictive power is only marginally lower than many richer survey measures. This provides some reassurance on its use in policy. [ABSTRACT FROM AUTHOR]

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step. [ABSTRACT FROM AUTHOR]

Background and aims Regulation of electronic cigarettes has moved to the top of the addiction policy agenda, as demonstrated by the recent focus across the United Kingdom on introducing age-of-sale restrictions. However, the views of those affected by such regulation remain largely unexplored. This paper presents the first detailed qualitative exploration of adolescents' perceptions of existing, and opinions about potential e-cigarette regulation. Methods Sixteen focus groups, including a total of 83 teenagers between the ages of 14 and 17 years, were conducted in deprived, mixed and affluent urban areas in Scotland and England between November 2014 and February 2015. Transcripts were imported into Nivivo 10, coded thematically and analysed. Results Participants critically considered existing evidence and competing interests in regulatory debates and demonstrated sophisticated understanding of the advantages and disadvantages of regulation. They overwhelmingly supported strong e-cigarette regulation and endorsed restrictions on sales to minors, marketing and e-cigarette use in public places. Concern about potential health harms of e-cigarette use and marketing increasing the acceptability of vaping and smoking led these adolescents to support regulation. Conclusions In focus group discussions, a sample of UK adolescents exposed to particular communications about e-cigarettes supported strict regulation of e-cigarettes, including banning sales to minors and use in indoor public areas. [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]

Terms such as 'oppida' have often obscured how we understand the nature and role of the dyke complexes which emerged at the end of the Iron Age. Developing from recent research at the Late Iron Age complex of Bagendon in Gloucestershire, this paper argues that a group of such polyfocal complexes share common characteristics, most significantly a relationship with 'banjo' enclosures, as part of wider landscape constructs. The paper suggests that the topography and morphology of these complexes have important implications for understanding the role of these sites and the nature of social change in the Late Iron Age. [ABSTRACT FROM AUTHOR]

This paper intervenes in the debate on ethnic segregation in British cities by paying attention to the hitherto neglected phenomenon of territorial stigmatisation. It discusses the stigma attached to the neighbourhood of St Paul's, Bristol; how it emerged, how it is felt and negotiated by local residents 'from below', and its effects on how that neighbourhood is managed by policy elites 'from above'. The paper critically reviews some recent influential treatments of ethnic segregation in the UK and the moral panic over ghettoisation, before explaining how the racialisation of urban space and extreme events such as the riots of 1980 and recent high-profile activities connected to Bristol's drugs economy have installed a damaging reputation of St Paul's as a segregated 'ghetto' of vice and dereliction. Using a mixed-methods approach, we show that black-white segregation in St Paul's is in fact low, and then explain how its ghetto reputation affects the experiences of residents. The paper concludes by arguing that in order to understand the complexities of ethnically diverse urban communities in Britain, territorial stigmatisation must be subjected to analytical scrutiny to complement the high-profile statistical approaches of recent years. [ABSTRACT FROM AUTHOR]

This paper examines the wider social impacts of hosting the London 2012 Olympic Games and its 'legacy' ambitions in East London, emphasizing securitization as an inbuilt feature of the urban regeneration project. Drawing on extensive original empirical research, the paper analyses the modalities of Olympic safety and security practices within the Olympic Park itself and their wider impact, while also connecting this research to theorization and debates in urban sociology and criminology. In this complex setting, a raft of formal and informal, often subtle, regulatory mechanisms have emerged, especially as visions of social ordering focused on 'cleansing' and 'purifying' have 'leaked out' from the hyper-securitized 'sterilized' environment of the Olympic Park and become embedded within the Olympic neighbourhood. In such complex circumstances, applying Douglas' (1966) work on purity and danger to the spatial realm provides a key conceptual framework to understand the form and impact of such processes. The imposition of order can be seen to not only perform 'cleansing' functions, but also articulate multiple symbolic, expressive and instrumental roles. [ABSTRACT FROM AUTHOR]

This paper is based on a qualitative study of recent Polish migrants in London (). The paper reveals the roles that different family members played in the migration narratives of these Polish migrants. In order to gain a broader understanding of migration patterns, it is necessary to explore what is meant by 'the family' and how this may operate transnationally. By examining spatially dispersed relationships, the paper aims to contribute to an understanding of transnational families. In addition, by highlighting the various ways in which families may be split, reunited, and reshaped through the process of migration, the paper argues for a need to explore the shifting ties between relatives 'here' and 'there'. The paper explores the dynamism of these relationships over time in the context of specific immigration regimes and the interplay with local attachments. [ABSTRACT FROM AUTHOR]

This paper responds to recent debates in human geography about ideal-type versus contingent neoliberalism, or what Gibson-Graham conceptualises as 'strong' vs 'weak' theory, by offering some reflections from an in-depth study of the private finance initiative (PFI) in England. It first introduces the history and purpose of the PFI as the Labour government's flagship public-private partnership (PPP) approach to public infrastructure modernisation. It then critically analyses its use in inner-city regeneration through a case study of a PFI housing scheme in the northern English city of Leeds. The paper argues that, when seen through the lens of 'strong theory', a PFI appears to be a consciously designed 'neoliberal straitjacket' intended to lock-in gentrification-based regeneration at the neighbourhood level, guarantee long-term profits to (finance) capital, and create powerful privatising and marketising pressures across the local public sphere. However, it is equally possible to construct a preliminary 'weak theory' of the PFI that unhides its inherent contradictions and shows how everyday activism by local community actors can successfully influence and contest how neoliberalism is rolled out on the ground. [ABSTRACT FROM AUTHOR]

This paper addresses the issue of how strategic-level partnerships, such as Local Safeguarding Children Boards, know about and learn from practice. The death of Baby Peter in Haringey exposed the dangers of reliance on numerical performance data alone to inform leaders about the true state of practice. The drivers for, and impact of, regulatory, media and political pressures on front-line practice and partnership behaviour are discussed with reference to the rise of organisational risk management and 'rule-based' responses (Munro, 2009). These are exacerbated by an overload of negative data about child protection systems which results in contagious 'attention cascades' which lead to over-simplification of complex issues and the rush to quick-fix solutions. This results in compliance-based responses designed to avoid 'blame', based on individualistic analyses of complex situations. Under these conditions, 'learning', such as from serious case reviews, can become regressive (how to avoid future culpability) rather than progressive (how to improve knowledge skills and practice). It is argued that understanding and improving practice require strategic partnerships to have engaged with front-line staff in order to access practice narratives as well as performance numbers, and to achieve an accurate and systemic analysis of the state of practice and how it can be improved. This calls for collective forms of knowing and reflecting and the paper concludes by describing examples. [ABSTRACT FROM AUTHOR]

This paper explores the environmental knowledge of small-scale rural landholders and comments on the implications of this for environmental policy. The paper draws on conceptualisations of knowledge as ‘know what’, ‘know why’, ‘know how’ and ‘know who’, recognises a distinction between tacit and codified environmental knowledges and highlights the need to consider the politics of knowledge surrounding environmental issues. Both quantitative and qualitative data are reported, and are derived from structured interviews with 30 small-scale landholders who were participants in a nature and landscape conservation initiative – the Landscape Heritage Scheme – within South Devon, England. These data are used to explore the place of environmental concerns within the land management objectives of respondents; the nature and extent of their environmental knowledge; how a range of factors alongside their environmental knowledge shaped the environmental practices of respondents; and the politics of knowledge associated with the Landscape Heritage Scheme. The paper suggests that small-scale landholders should be of interest to environmental policy, prioritising environmental objectives in their land management, being relatively knowledgeable about the environment and highly responsive to environmental advice and financial incentives that support environmental management. A case is made for developing research in this area, given ongoing processes of rural demographic change and the rising importance within this of an increasingly diverse landholding population. [ABSTRACT FROM AUTHOR]

A pair of papers re-examined the evidence from a national initiative to train all teachers in England to bring them up to the level of newly qualified teachers, who are required to know when to use and when not to use information and communication technologies (ICT) in their professional practice. The first paper confirmed that multilevel evaluation of professional development was robust for ICT teacher training. This second paper contrasts the highest and lowest rated designs for ICT teacher training: an ‘organic’ approach that provided training in schools was highly rated, whereas a centralised computer-assisted learning approach with online access to trainers was the lowest rated design. The study supports an ecological view of the diffusion of ICT innovations in education and recommends that ICT teacher training be designed to support evolution of each teacher's classroom, school and region, as well as the training of the ICT teacher trainers. [ABSTRACT FROM AUTHOR]

This paper discusses developments in the last five to six years in the provision of operational flood forecasting in England, Wales, and Scotland. Before the formation of the Environment Agency EA in England and Wales and the Scottish Environment Protection Agency SEPA, flood forecasting capabilities were fragmented. Just over a decade ago both organisations received governmental mandates for the provision of flood forecasting and warning nationally, and have as a result in recent years established systems providing national coverage: the National Flood Forecasting System, and Flood Early Warning System FEWS Scotland. These have facilitated a rapid expansion of catchments for which forecasts are provided, and the common framework used has enabled a more rapid introduction of scientific advances in forecasting techniques. This paper gives an overview of some of these recent developments, as well as providing an outlook to further developments to be undertaken in the near future. Copyright © 2009 Royal Meteorological Society [ABSTRACT FROM AUTHOR]

This paper seeks to explore the role of school meals policy in the UK, and more particularly its articulation in England. It will outline the history of this policy and examine a number of changes that have taken place over time. The focus will be on nutrition and how the emphasis has shifted from issues of quantity to the composition of food eaten by children. The nutritional argument will be examined by exploring the changes in the governance of the population, as represented by school meals policy. Finally, the paper will address the awkward relationship between the state and children, as evinced by school meals policies. [ABSTRACT FROM AUTHOR]

This paper describes and discusses critically a unique experiment in using a combination of broadcast television and an interactive Web site to reach people interested in business and management. The Open University's Business School, in collaboration with the BBC mounted the project, called The Business Café . The paper outlines the contents of the nine broadcasts and the site, which changed weekly. Developing the broadcasts and maintaining the site required complex procedures and teamwork. The broadcasts attracted an audience of 300,000 UK viewers and the Web site recorded over 60,000 visits during the series. The stakeholders and others who offered much constructive criticism, identified more project outcomes during an evaluation. Useful lessons emerged, in particular about cross-team working and about learning from asynchronous networks like the Web. Web site:http://www.open.ac.uk/businesscafe [ABSTRACT FROM AUTHOR]

Stenhouse's original vision of teacher research incorporated a strong emphasis on curriculum construction, interpretation and evaluation. This curricular emphasis is less prevalent in the present in the dominant 'professional development' and 'what works' traditions of teacher research. It is shown here, however, that this curricular focus has been maintained in the published discourse of history teachers in England. Using a citation analysis to illuminate the growth of professional knowledge, this paper shows how curricular issues drove history-teacher published discourse between 2004 and 2013, and how this discourse drew upon a highly subject-specific knowledge base in this period. Research by teachers in a tradition of 'curriculum theorising', it is argued here, could prove to be a powerful component in establishing a more systematic knowledge base for the profession. [ABSTRACT FROM AUTHOR]

In this paper, I use the case of the marketisation of higher education in England to contribute to the growing interest in placing markets, and processes of market making, more centrally within economic geographical research agendas. In particular, my argument focuses on the spatiality of marketisation through the specific case of the introduction of undergraduate student fees in England from 1998 onwards. I argue that the marketisation of English higher education has operated, implicitly at least, with a territorial logic in which students fees are justified through an assumption that the value of a degree from an English university will arise from graduate salary premiums in domestic graduate labour markets. However, I demonstrate how English higher education overflows this territorial framing through the internationalisation of student choice and graduate labour markets in ways that challenge the marketisation process itself. This analysis reveals the hitherto comparatively neglected role of extra-territorial relations in marketisation and the importance of these geographies for the future marketisation of higher education. [ABSTRACT FROM AUTHOR]

To see how contemporaries understood the body’s place in differences between men’s and women’s homicidal violence, this paper disaggregates the data from a sizeable sample of English homicide records produced between c.1500–1680 to see who men and women were accused of killing, and how, and places that information within the context of early modern medical and legal works. Women killed far fewer people than did men, which accords with studies of homicide in other times and places; but if we include in our counts (as contemporaries would have done) both infanticide and killings by means of witchcraft, we see that women were disproportionately represented amongst those deemed to have committed murder rather than the less serious crime of manslaughter. Early modern responses to homicide, and thus the long-lived laws that grew from them and the bodies of evidence upon which we rely, had embedded within them humoural understandings of male and female difference that were premised on variations in vital heat. More so than their ‘hot-blooded’ counterparts, women were associated with cold-blooded killings. [ABSTRACT FROM AUTHOR]

This paper describes one part of a feasibility study carried out in England which examined the costs, quality and effectiveness of continence services in areas with different approaches to provision. It involved the design of instruments to collect the views and perceptions of patients and an investigation of ways to develop a methodology to implement comparative studies. It is the design and piloting of the questionnaires and the way patients responded that forms the focus of this paper. The main sample group recruited for the study were women who had recently sought formal help with urinary incontinence and were likely to receive conservative treatment or management in the community. They were interviewed and asked to complete four questionnaires at two points in time. A smaller sub-group of disabled women, interviewed only once, were included to compare cost profiles for different client groups. The questionnaires which were developed address the impact of urinary incontinence (using a standard scale), the effectiveness of service provision in terms of patients’ clinical history, expectations and hoped-for outcomes, service receipt and its cost, and patients’ satisfaction with several aspects of service provision. In total 118 women were interviewed, including 28 disabled women. The study generated a set of survey instruments which might be used for a variety of purposes including audit and future research and which could inform purchaser and provider decisions by using patients’ perspectives of quality of life outcomes to enhance service development. [ABSTRACT FROM AUTHOR]