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Purpose Comment on the contribution that housing can make to delivering better health and wellbeing outcomes. More specifically, the purpose of this paper is threefold: summarise recent evidence that makes the case for housing in helping to address health and social care issues; comment on the challenges and opportunities of partnership working; and describe examples of interesting and innovative local joint provision.Design/methodology/approach Draws on the author's briefing papers on housing, health and social care for housing quality network, which is a national housing consultancy organisation as well as the author's role as Chairperson of East Midlands Housing Care and Support, which is a regional housing association.Findings Collaboration between housing, health and social care is making slow progress at the national level in England. This is despite an ever-increasing evidence base highlighting that good housing can help to address issues, such as delayed discharges. Nevertheless, there are an increasing number of interesting examples of successful local initiatives on housing, health and adult social care. The way forward is to facilitate joint working at a local level.Originality/value Focusses on the success of examples of local joint working between housing, health and social care to achieve better outcomes for vulnerable people. [ABSTRACT FROM AUTHOR]

The decommissioning of a health‐care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179–183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health‐care contexts, complex change processes and institutional constraints. Data include interviews, non‐participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel. [ABSTRACT FROM AUTHOR]

Metaphors are inescapable in human discourse. Policy researchers have suggested that the use of particular metaphors by those implementing policy changes both influences perceptions of underlying reality and determines what solutions seem possible, and that exploring 'practice languages' is important in understanding how policy is enacted. This paper contributes to the literature exploring the generative nature of metaphors in policy implementation, demonstrating their role in not just describing the world, but also framing it, determining what is seen/unseen, and what solutions seem possible. The metaphor 'care pathway' is ubiquitous and institutionalised in healthcare. We build upon existing work critiquing its use in care delivery, and explore its use in health care commissioning, using evidence from the recent reorganisation of the English NHS. We show that the pathways metaphor is ubiquitous, but not necessarily straightforward. Conceptualising health care planning as 'designing a pathway' may make the task more difficult, suggesting a limited range of approaches and solutions. We offer an alternative metaphor: the service map. We discuss how approaches to care design might be altered by using this different metaphor, and explore what it might offer. We argue not for a barren language devoid of metaphors, but for their more conscious use. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning disability, autism or both to live more independent and better quality lives in their own home rather than spending many years in hospital unnecessarily.Design/methodology/approach The methodology applied was to capture the real experience of a person with a learning disability, autism or both who successfully moved from long-term hospital care to home. This was achieved through developing a narrative story by capturing their experiences in their own words and the words of the individual's support team who made this life changing event possible.Findings This story shows how with the right planning and support, people with a learning disability can live in their own homes, gain their independence and be supported to take risks.Originality/value This is an original case study that has not been published previously and has been written for the sole purpose of this journal. [ABSTRACT FROM AUTHOR]

Background: Leadership development impacts on quality of care and on workplace cultures for staff. Clinical leadership embracing transformational and other collective leadership approaches is a key enabler for developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal interprofessional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had been unsuccessful in engaging medical doctors for more than two years. Aims and objectives: This paper shares how a dedicated, practice development-based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become transformational and collective leaders, and facilitators with the skills to develop and sustain person-centred, safe and effective workplace cultures. Methods: Practice development methodology, with its collaborative, inclusive and participative approach to developing person-centred cultures, combined with clinical leadership strategies, formed the basis of the programme. It emphasised the use of active and action learning, drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and collective thinking about clinical leadership, together with collaborative analysis of evaluation data, led to the synthesis of insights through the use of reflection and action planning. Findings: These are presented at two levels: 1. Five individual reflections by authors to illustrate their leadership journeys, which also demonstrate the use of a range of tools and their impact. Insights and learning include recognition of the benefits of peer support and networking, development of a disciplined approach to learning, and self-management 2. A collaborative reflection and critique that embraced a sense of team ethos and community cohesion, for the first time in a safe environment, as well as a sense of shared purpose and values. Conclusions: The programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled medical clinical leaders to embark on a journey of self-transformation. Implications for practice: • An internal model grows clinical leadership capacity across an organisation through peer support and networking, and collective leadership • Investing in a safe, confidential space for clinical leads and other staff groups is a potentially effective strategy for leadership development practice • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates the potential to enable transformative and collective leadership to promote person-centred cultures in the workplace [ABSTRACT FROM AUTHOR]

A case study was conducted in 2016 to evaluate the effectiveness of an innovation to enable people with "complex" care requirements to be discharged from hospital to an appropriate service for their care, without using the NHS England Continuing Health Care (CHC) assessment. The setting was a rural district general hospital in England, where the quality outcomes and cost‐effectiveness of the CHC assessment being conducted in hospital were giving cause for concern. The NHS CHC Framework advocates conducting these assessments in the community where a more accurate indication of long‐term care can be determined. The "5Q Care Test" was collaboratively developed with health and social care partners, care providers, and CHC interest groups, including users of the services. It was implemented as a tool to support moving the CHC assessment into the community, as it enabled practitioners to swiftly determine patients' appropriate initial care pathway out of hospital. A full economic impact analysis was conducted 7 months after the tool was introduced. The results showed significant improvement in the quality and cost‐effectiveness of the "5Q Care Test," with a reduction in the hospital length of stay, which is known to be associated with improved outcomes for patients and financial savings. [ABSTRACT FROM AUTHOR]

Background: The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect patient feedback to support service improvement. To provide a sustainable mechanism for the PRASE intervention, a 2‐year improvement project explored the potential for hospital volunteers to facilitate the collection of PRASE feedback. Objective: To explore the implementation of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders. Design: A qualitative case study design was utilized across three acute NHS trusts in the United Kingdom between March 2016 and October 2016. Ward level data (staff interviews; action planning meeting recordings; implementation fidelity information) were analysed taking a pen portrait approach. We also carried out focus groups with hospital volunteers and interviews with voluntary services/patient experience staff, which were analysed thematically. Results: Whilst most ward staff reported feeling engaged with the intervention, there were discordant views on its use and usefulness. The hospital volunteers were positive about their involvement, and on some wards, worked with staff to produce actions to improve services. The voluntary services/patient experience staff participants emphasised the need for PRASE to sit within an organisations' wider governance structure. Conclusion: From the perspective of key stakeholders, hospital volunteers facilitating the collection of PRASE feedback is a feasible means of implementing the PRASE intervention. However, the variability around ward staff being able to use the feedback to make changes to services demonstrates that it is this latter part of the PRASE intervention cycle that is more problematic. [ABSTRACT FROM AUTHOR]

Background Little attention has been paid on the carbon footprint of different healthcare service models. We examined this question for service models for patients with acute ST elevation myocardial infarction (STEMI). Methods We estimated carbon emissions associated with ambulance (patient) transport under a primary percutaneous coronary intervention (pPCI) care model based in tertiary centres, compared with historical emissions under a thrombolysis model based in general hospitals. We used geographical information on 41 449 hospitalizations, and published UK government fuel to carbon emissions conversion factors. Results The average ambulance journey required for transporting a STEMI patient to its closest care point was 13.0 km under the thrombolysis model and 42.2 km under the pPCI model, producing 3.46 and 11.2 kg of CO2 emissions, respectively. Thus, introducing pPCI will more than triple ambulance journey associated carbon emissions (by a factor of 3.24). This ratio was robust to sensitivity analysis varying assumptions on conversion factor values; and the number of patients treated. Conclusions Introducing pPCI to manage STEMI patients results in substantial carbon emissions increase. Environmental profiling of service modernization projects could motivate carbon control strategies, and care pathways design that will reduce patient transport need. Healthcare planners should consider the environmental legacy of quality improvement initiatives. [ABSTRACT FROM PUBLISHER]