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Never before have public sector jobs been so threatened. Fear and anxiety have shifted their focus, from performance to survival. With reference to immediately contemporary works on the NHS in particular, such as Mandelstam (2011) and Leys and Player (2011), the paper establishes the factual validity of the crisis. The authors conducted a series of workshops for public sector staff to enable them to explore their reactions to the current situation. It is possible to identify increasing levels of denial and other forms of resistance to change similar to those first identified by Menzies' (1959). Drawing on the work of Bion (cited Obholzer & Roberts, 1994) the paper considers the dangers of a retreat to the paranoid schizoid position, and identifies a theoretical clue in Halton (2004) for turning the trauma of change into a creative opportunity. Art has access to emotional, spiritual and creative facets of the human mind that science cannot explore. Klein's (1975) consideration of the infantile and regressive aspect of art is acknowledged. The paper then considers what is revealed by a study of specific works of art which were presented in the workshops; including paintings by Bosch, Rousseau, Breughel and Goya. The work of Zagier-Roberts (1998) and Winnicott (1971) is called upon to endorse the usefulness of such a playful collage of responses. Art can be used to help people move through Kubler Ross' stages of bereavement (1997); not to acceptance but out of the paranoid schizoid position into the depressive position (Klein 1975). Revisiting the work of Halton (2004) and the concept of evolutionary creativity, a move on from the depressive position can begin. Collective validation can be affirmed through a rebooting of the essential public sector values while a radical turning away from organisational priorities, to face the service user, provides a more far reaching optimism than any envisaged by an essentially limited demand for modernisation. In conclusion the paper considers the recent contributions of Dienst (2011) and Dumenil and Levy (2011) to advocate tactical resistance to the denigration of the public sphere. [ABSTRACT FROM PUBLISHER]

The strengthening of health systems is fundamental to improving health outcomes, crisis preparedness, and our capacity to meet global challenges, such as accelerating progress towards the Millennium Development Goals, reducing maternal and child mortality, combating HIV, malaria and other diseases, limiting the effects of a new influenza pandemic, and responding appropriately to climate change. To meet these complex needs, the Association of Schools and Programs in Public Health, the World Health Organization, and the Institute of Medicine promote systems thinking as the only sensible means to respond to issues that greatly exceed the normal capacity of health and medical services. This paper agrees with the application of systems thinking but argues that health organizations have misunderstood and misapplied systems thinking to the extent that the term has become meaningless. This paper presents the basic constructs of systems thinking, explains why systems thinking has been misapplied, examines some misapplications of systems thinking in health, and suggests how the concept can be applied correctly to medicine and public health to achieve the reason it was adopted in the first place. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to investigate the prescribing behavior and applied practices of doctors who are the heads of clinical departments in the National Health System in Greece. Moreover, this paper aims to evaluate a set of factors influencing them in this conduct through both their scientific and managerial status. Design/methodology/approach – The sample consisted of 123 clinical department-heads in 15 hospitals and a questionnaire specifically designed for the purposes of this research effort was used. Prescribing criteria were divided into three categories: scientific, functional and behavioral. Demographic data were also included. The data were processed using SPSS17 statistical package. Multivariate Analysis of Variance (MANOVA) of the mean of the parameters identified was applied. Findings – The survey assessed, revealed and evaluated the most important factors affecting the selection process of selecting pharmaceuticals on a department head level. Existing gaps in scientific information and rational management of procedure implementation were detected. Different perceptions of doctors-department heads towards prescribing criteria emanating from their previous experience on decision-making positions, age and hospital spatial characteristics (urban-provincial) were also highlighted. Originality/value – The results of this survey provide both researchers and health policy makers with a better insight of the factors influencing prescribing behavior, and decision-making processes of doctors-department heads in the context of a Public Health Care System. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to examine the leadership role of the ward sister/charge nurse in the English National Health Service and demonstrate that its influence in maintaining standards of care has been undermined. Design/methodology/approach – This is achieved through a critical review of the relevant research and policy literature. Evidence relating to recent failures in the provision of nursing care is summarised to establish the nature of the problem. This is followed by an analysis of existing research concerned with the ward sister/manager role in the context of recent policy. Findings – The evidence demonstrating that the ward sister/charge nurse is one of the key determinants of quality care has been overlooked in recent years and this in part accounts for the quality failures that have occurred in NHS hospitals of late. Practical implications – Action is needed to place the ward sister/charge nurse at the heart of the hospital system. Systems of organisational and mutual support are needed to ensure that these ward-based leaders can reach their full potential as the guardians of care. Originality/value – The perspective offered in this paper illustrates how a solution to pressing organisational problem can be found through accessing the appropriate literature. Although the recommended action may not be "new" it is novel in the sense that it is based on rediscovering a role that already exists and can be supported to bring about change, rather than seeking wholesale complex change. [ABSTRACT FROM AUTHOR]

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Research on quality adjusted life year (QALY) has been underway for just over 50 years, which seems like a suitable milestone to review its history. The purpose of this study is to provide a historical overview of why the QALY was developed, the key theoretical work undertaken by Torrance, Bush and Fanshel and how two seminal papers shaped its subsequent development. Moving the QALY forward – there are several historical and reflective exercises. The historical interplay between politics, policy and the challenges facing the National Health Service (NHS) in formulating the QALY concept in the UK has been explored in some depth already, whilst the conceptualization and development of the methodological framework is relatively underexplored. We address this gap by viewing the QALY through the lens of the methodological debates, reflecting upon two key papers underpinning the QALY methodology and how these methods have been developed over time. In part the changes in technology e.g. Google Scholar, and the availability of tools to search for early uses of the QALY allow us to better understand the historical context in which the theoretical development of the QALY has taken place. Here we celebrate two seminal papers that shaped early QALY development. The first section provides a history of these papers, summaries their contributions and explores the uptake of these papers over time. The second section reviews the methodological debates that have surrounded the QALY over the last 50 years and looks at how the QALY has moved to address these challenges. The third section presents the voices of diverse commentators representing the field of health economics who have contributed to the subsequent development of the QALY in both theoretical and empirical capacities and captures their thoughts about future research and policy use of QALYS. • Two seminal papers from North America define the QALY we know today. • Systematic searches identified 716 papers citing both these seminal papers. • Co-citation analysis and visualisations highlight a range of methodological topics. • Behavioural theories are shown to inform research into how we get the numbers. • Research is also needed on what the numbers mean and what aspects to incorporate. [ABSTRACT FROM AUTHOR]

COVID-19 brought a lot of children's routine clinical services in the UK to a complete halt in March 2020. The NHS had to radically change the way clinical services are provided with the rapid introduction of telemedicine, virtual consultations, and video conferencing facilities to support team working. This paper describes how Peterborough Child Development Centre rapidly redesigned the services with digital tools to continue offering neurodevelopmental and neurodisability services more virtually. We demonstrate how we adapted our approaches to assess and manage complex long-term conditions with improved quality and outcomes by using digital tools. The changes to the clinical processes and systems are here to stay beyond the COVID-19 pandemic and have the potential to revolutionise the services. [ABSTRACT FROM AUTHOR]

Starting in 2002, the UK Labour Government of 1997–2010 introduced a series of changes to the National Health Service (NHS) in England designed to increase patients’ choices of the place of elective hospital care and encourage competition among public and private providers of elective hospital services for NHS-funded patients. In 2006, the Department of Health initiated the Health Reform Evaluation Programme (HREP) to assess the impact of the changes. In June 2008, the White Paper, High quality care for all, was published. It represented the government’s desire to focus the next phase of health care system reform in England as much on the quality of care as on improving its responsiveness and efficiency.The 2008 White Paper led to the commissioning of a further wave of evaluative research under the auspices of HREP, as follows:an evaluation of the implementation and outcomes of care planning for people with long-term conditions;an evaluation of the personal health budget pilots;an evaluation of the implementation and outcomes of the Commissioning for Quality and Innovation (CQUIN) framework; andan evaluation of cultural and behavioural change in the NHS focused on ensuring high quality care for all.This Supplement includes papers from each project.The evaluations present a mixed picture of the impact and success of the 2008 reforms. All the studies identify some limitations of the policies in the White Paper. The introduction of personal health budgets appears to have been the least problematic and, depending on assumptions, likely to be cost-effective for the sorts of patients involved in the pilot. For the rest of the changes, impacts ranged from little or none (CQUIN and care planning for people with chronic conditions) to patchy and highly variable (instilling a culture of quality in acute hospitals) in the three years following the publication of the White Paper. On the other hand, each of the studies identifies important insights relevant to modifying and improving the policies. These findings have continuing relevance since both the 2008 White Paper’s policies, and the issues they were focused on remedying, remain central to the current Coalition Government’s reform agenda. [ABSTRACT FROM PUBLISHER]

Purpose – There are major pressures on social care funding for people with learning disabilities. It is unsustainable to continue working in the same way. The need to promote independence and prevent the need for social care for people with a learning disability is urgent. The purpose of this paper is to highlight key issues, stimulate debate and strengthen the evidence base. Design/methodology/approach – The paper takes evidence from research, literature reviews, statistics and policy debates. It illustrates key points with case studies. The argument for change has been developed in discussion with key stakeholders including the chief executive of a leading self-advocacy organisation. Findings – Demand is increasing whilst funding is reducing. Policy, practice and evidence on prevention of the need for social care for people with a learning disability are underdeveloped. Nevertheless, there are many examples of good practice, and of emerging opportunities for local partnerships to work together to build a new approach. Research limitations/implications – Research on the benefits and costs of prevention of social care for people with a learning disability is underdeveloped. There is a need to extend the evidence base on the range of interventions and their effectiveness. Originality/value – The paper argues for a step change in culture, practice and the focus of research. [ABSTRACT FROM AUTHOR]

Purpose of study Initiatives to standardise hospital paper-based prescription charts are underway in various countries in an effort to reduce prescribing errors. The aim of this study was to investigate the extent to which prescribing error rates are influenced by prescription chart design and familiarity. Study design In this prospective, randomised, cross-over study, Foundation Year 1 doctors working in five Scottish National Health Service (NHS) Boards participated in study sessions during which they were asked to prescribe lists of medications for five fictional patients using a different design of paper prescription chart for each patient. Each doctor was timed completing each set of prescriptions, and each chart was subsequently assessed against a predefined list of possible errors. A mixed modelling approach using three levels of variables (design of and familiarity with a chart, prescribing speed and individual prescriber) was employed. Results A total of 72 Foundation Year 1 doctors participated in 10 data-collection sessions. Differences in prescription chart design were associated with significant variations in the rates of prescribing error. The charts from NHS Highland and NHS Grampian produced significantly higher error rates than the other three charts. Participants who took longer to complete their prescriptions made significantly fewer errors, but familiarity with a chart did not predict error rate. Conclusions This study has important implications for prescription chart design and prescribing education. The inverse relationship between the time taken to complete a prescribing task and the rate of error emphasises the importance of attention to detail and workload as factors in error causation. Further work is required to identify the characteristics of prescription charts that are protective against errors. [ABSTRACT FROM AUTHOR]

Purpose – To compare the characteristics of parents and children recruited for two randomised-controlled trials (RCTs) of parenting support in disadvantaged communities in Wales in order to explore the effects of community-based vs individual-based targeting in early prevention. Design/methodology/approach – Parents from high-risk disadvantaged communities in Wales, where additional early intervention services were targeted as part of a Welsh Government early intervention strategy, were recruited to two RCTs of parenting interventions. In the first study parents of targeted three- and four-year-old children, who were screened, and deemed at risk of long-term problems, were recruited from Sure Start (SS) areas in Wales. In the second study parents of one- and two-year-old children living in disadvantaged Flying Start (FS) areas were recruited, with residence within the FS area being the only recruitment criterion. Findings – FS areas are more strategically targeted as communities with a greater percentage of families with high levels of socio-economic disadvantage and associated risk than SS areas. Families in the toddler parenting trial based in FS areas, recruited without any additional screening, were experiencing higher levels of socio-economic deprivation, mental health problems and parenting stress as well as other known risks to child outcomes than the general population. However, when compared with the individually targeted population recruited for the SS study, they were shown to be experiencing significantly lower levels of these and other risks factors for poor child outcomes than the sample recruited for the SS trial where recruitment was based on known child risk factors. The paper discusses these findings and explores the implications of targeting by geographical area (community level targeting) alone vs targeting individual families by known risk factors. The findings suggest that screening measures would identify children at greatest risk of poor outcomes and whose families might benefit from additional targeted services. Suggestions for possible screening measures are also made.Originality/value – This paper contributes to discussion about effective ways of allocating limited resources to best effect. [ABSTRACT FROM AUTHOR]

Background The evidence on public health interventions has traditionally focussed on a limited number of costs and benefits, adopted inconsistent methods and is not always relevant to the UK context. This paper develops a multi-criteria decision analysis (MCDA) approach to overcome these challenges. Methods A document review and stakeholder consultation was used to identify interventions and the criteria against which they should be assessed. The interventions were measured against these criteria using literature reviews and decision models. Criteria weights were generated using a discrete choice experiment. Results Fourteen interventions were included in the final ranking. Taxation was ranked as the highest priority. Mass-media campaigns and brief interventions ranked in the top half of interventions. School-based educational interventions, statins and interventions to address mental health problems ranked in the bottom half of interventions. Conclusions This paper demonstrates that it is possible to incorporate criteria other than cost-effectiveness in the prioritization of public health investment using an MCDA approach. There are numerous approaches available that adopt the MCDA framework. Further research is required to determine the most appropriate approach in different settings. [ABSTRACT FROM AUTHOR]

The decision by the Department of Health to introduce amendments to the uniform and workwear policy for the NHS in response to increasing problems with infection control seemed uncontroversial. There was, however, some difficulty with implementing the policy, which arose largely because of the conflict this caused for staff who wished to keep their arms covered for reasons which stemmed from religious beliefs. This paper uses textual analysis to examine how those reasons and challenges were discussed in online commentary within a medical and nursing journal. The papers shows that there was a marked difference in how the two groups of professionals responded to the changes to workwear, and exposes a worrying degree of religious intolerance expressed by contributors to the nursing journal. [ABSTRACT FROM AUTHOR]

AIM-This paper assesses alcohol policies and interventions in Finland and the Canadian province of Ontario, using the policy options and interventions recommended in WHO's Global strategy to reduce the harmful use of alcohol (2010). DATA & METHODS - The information and data are based on archival sources, surveys, legislative and government documents, and published papers. The paper assesses both jurisdictions on 10 areas in the WHO document and their sub-topics: 1. leadership. 2. health services response. 3. community action. 4 drinking and driving policies and countermeasures. 5. availability of alcohol. 6. marketing of alcoholic beverages. 7. pricing policies. 8. reducing the negative consequences of drinking and alcohol intoxication. 9. reducing the public health impact of illicit alcohol and informally produced alcohol, and 10. monitoring and surveillance. RESULTS - Ontario had several recent noteworthy developments in line with WHO recommendations: health services response, controls of drinking and driving, pricing policies, reducing the negative consequences of drinking and intoxication, and monitoring and surveillance. Finland has emphasised pricing policies in recent years, and there have also been significant developments in community action, controls of drinking and driving, alcohol advertising, and monitoring and surveillance. CONCLUSIONS - Challenges and opportunities for strengthening the policy responses are noted, as well as topics for future research. [ABSTRACT FROM AUTHOR]

This paper introduces the major issues related to the Health Insurance Act and the core content of recent precedents, in order to prevent health insurance arguments and to contribute to health insurance-related administrative litigation. The basis of Koreas health insurance system is the National Health Insurance Act. After providing medical services, the medical cost is covered by the National Health Insurance Corporation (NHIC). If the doctor was paid deceptively or improperly, then the NHIC will seize the entire payment, and the Minister of Health and Welfare will order the doctor to suspension practice or, similarly, fine the doctor for five times the original payment. In addition, doctors who have used deception will have their license suspended. If the doctor has any objection against this administrative measure, he or she can file an administrative lawsuit. So far, if the action was illegal, the court has generally made principle-based judgments, regardless of whether the behavior was intentional or negligent; however, recently, especially in cases related to the court of first instance (only a few cases), the court has made a judgment clearly cancelling the measure under the condition that the measure was beyond the level by analyzing the reason why the practitioner committed an offense. From the practitioners point of view, it is encouraging that the judges have started to understand the reality of the medical field. Further, this paper argues that judges should increase their understanding the medical field and specific validity. This article reviews the litigation process related to the National Health Insurance Act and recent trends in its precedents. From now on, these judgments should support the arguments of practitioners. Conclusively, these judgments were the result of legal actions; therefore, doctors should avoid taking an attitude of annoyance toward lawsuits or being intimidated by the organization, and as a result, respond passively by simply paying out the lawsuit settlements. [ABSTRACT FROM AUTHOR]

This paper celebrates 25 years of the existence of the Brazilian National Health System (SUS). Through out the paper, one describes the political and institutional mechanisms from which SUS originated, as well as the transformations undergone in the past 25 years. The conquers obtained with the implantation of the system are specially highlighted, particularly those concerning access to health services gained by the population and health gains per se, once these are the ultimate objective of the system. Conversely, the difficulties that hinder the good functioning of SUS are also noted, mainly difficulties in access and financing. The paper points out that these two fundamental issues must be addressed in order for the system to become really equitable, as it proposes itself to be. [ABSTRACT FROM AUTHOR]

Since the introduction of devolution in 1999 there has been a growth in comparative analysis of the National Health Service (NHS) as it has developed between England, Scotland and Wales. Several analyses have considered funding and policies on provision and performance, usually noting the difficulties in carrying out comparative evaluation. Few studies to date have included detailed analysis of Northern Ireland and this paper seeks to set out and analyse the organisation of the NHS in Northern Ireland. The focus is on the structures of the NHS as it has developed since devolution and relates to similar structures in the NHS in England, Scotland and Wales. The analytical approach in the paper uses the concept of policy copying to interrogate the structural and institutional organisation of the NHS in Northern Ireland. This facilitates an assessment of the degree of divergence between Northern Ireland and the other UK countries, and the nature and scope of policy copying. The article then seeks to explain the reasons for both policy copying and the rejection of policy copying, and how this may have led to identifiable policy deficiencies. [ABSTRACT FROM AUTHOR]

This paper explores why leadership, especially senior leadership in British organizations, is persistently nearly always white. The paper contends that beneath the veneer of our apparent commitment to equal opportunities, primitive often unconscious factors operate to ensure that leadership remains white, thus reproducing a racial hierarchy in the workplace. It argues that the barriers to black and minority ethnic people getting appointed to leadership positions in organizations today are largely invisible and are hidden within the psyches of decision makers, the cultures of white organizations, and their combined impact on the confidence of black and minority ethnic staff. [ABSTRACT FROM PUBLISHER]

This paper will offer an alternative paradigm to healthcare delivery by introducing the concept of mutuality and empowerment into the existing health-wealth model. The backdrop is provided by Better Health, Better Care (Scottish Government ), Section 1 of which is entitled 'Towards a Mutual NHS'. In detail, the paper will: revisit what is meant by mutuality; advance the meaning of the `public interest'; explore empowerment and community empowerment and its relationship to health; and introduce a model, which tries to link these concepts and terms together. It is hoped that this analysis will help researchers and practitioners alike further appreciate the important concept of mutuality and empowerment into the existing health-wealth model. [ABSTRACT FROM AUTHOR]

Purpose This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning. Design/methodology/approach A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five "best practice" sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups. Findings - Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties. Research limitations/implications -Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked. Practical implications - It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop. Originality/value - This is one of the first large-scale studies of joint commissioning conducted in England. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme. Design/methodology/approach - This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA. Findings Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole-person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care. Originality/value - This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Background Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. Design A systematic literature review. Methods The terms ' Releasing Time to Care' and ' Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, Pro Quest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. Results The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. Conclusion The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. Relevance to clinical practice This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. [ABSTRACT FROM AUTHOR]

Purpose – This paper seeks to suggest that social housing can and should be the local hub for cost-effective, human-scale health and wellbeing. It aims to explore the way that community-based housing providers can help health and social care services to deliver long-term wellbeing. Design/methodology/approach – The argument is illustrated with examples of constructive practice drawn from membership of the PlaceShapers Group of housing associations, across different parts of England. Findings – Localism and promotion of public health lie at the roots of social housing, dating back more than 150 years. Because of their physical stake and presence in communities, social landlords are able to offer combined homes and support in a way and on a scale that few private operators can match. So social housing providers are in a prime position to add value and recast the relationship between health, wellbeing, social care and housing. But social housing organisations and their leaders will need to be highly inventive, enterprising and determined to reap the full rewards for service users and neighbourhoods. Practical implications – Changes to the health, wellbeing and social care landscape, coming into effect in England and Wales from April 2013, present a unique opportunity to bridge the "parallel worlds" of housing and health. Local housing providers now have the chance to bond their long-term presence, commitment and investment in communities to the new outcomes required for health and social care. Originality/value – The lead author is chair of a grouping of community-based housing associations working throughout England and is especially well placed to identify examples of innovative practice, such as those described in the paper. [ABSTRACT FROM AUTHOR]

Purpose -- NHS reforms in England led to the establishment of Local Education and Training Board (LETBs) to ensure the future supply of staff. LETBs have an important role in addressing health and social care integration. This paper aims to stimulate debate, ideas and opportunities to improve integrated worldorce planning, practice and policy. Design/methodology/approach -- This is a thought leadership article which presents a distillation of key policy and strategy, drawing out implications for policy makers and workforce planners at a strategic level. Findings The paper describes and critically appraises the role of LETBs in supporting integration between health and social care. The key messages include: ensure social care and public health representation on the board, track education and training decisions against commissioning priorities, focus on outcomes and transition points, build health-related skills in social care, support providers and use performance measures of integration. Practical implications -- LETBs need to demonstrate an open and transparent approach to workforce education and planning. All partners need to engage including social care and public health service commissioners and providers. Originality/value -- There is a substantial body of literature on integration, although much less is devoted to examining workforce. This article will be of particular interest to LETB leaders, those responsible for reviewing and assessing the performance of LETBs as well as social care leaders and worldorce planners. In addition the article will be of interest to those supporting integrated workforce planning and development across the UK and internationally. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to enable busy clinicians to review the contents of the journal quickly. They can then choose which articles have the most relevance for them and focus on these. Design/methodology/approach – The paper provides a brief synopsis of the main content of the journal prepared by the review editor. Findings – Changes to healthcare commissioning and delivery will have long-term consequences for the way in which the NHS functions. Practical implications – It is important that all NHS staff have a clear understanding of recent and proposed changes so that they can participate in dialogue about the implications for their roles. Originality/value – The review editor has no affiliation with any of the authors and no financial or other interest in commissioning and therefore is able to provide an independent overview of the journal contents. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to examine public spending cuts and welfare reforms to assess winners and losers amongst older people, children, young people and families. It proposes ways in which intergenerational fairness could be achieved through taxing wealthier older people. Design/methodology/approach – The paper reviews and analyses spending and policy plans from 2010 onwards, and draws conclusions. Findings – The paper concludes that children, young people and families are the relative losers of government spending cuts and reforms; older people have been relatively protected; the focus should be on taxing wealthier older people; intergenerational fairness needs to be addressed. Originality/value – Research tends to focus on one age group, so there have not been many studies which contrast the impact of public policy on different age groups. The concept of intergenerational fairness is only beginning to be discussed. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to provide an overview of the Achieving Age Equality Toolkit, to give the background to its development, and to advise readers of the ways in which it has already been successful in the health and social care arena. Design/methodology/approach – The subject of this paper is the ban on age discrimination in goods and services that came into force on 1 October 2012. The objectives of the paper are achieved by setting out the policy context, and by detailing how the age equality recommendations were made through an independent review. Findings – Older people have different experiences of health and social care services, but most want to be able to access support when they need it. Age as a barrier to treatment and screening in areas such as mental health and cancer continue to give cause for concern. Organisations need to ensure they are working in an "age equal" way across services. Research limitations/implications – Implications for further research could include an assessment of the extent of "institutional ageism" in services after the ban on age discrimination in goods and services on 1 October 2012. Practical implications – The article illustrates through case studies how use of the toolkit enables one organisation to better identify where changes are needed towards embedding anti age discrimination practice. Social implications – As well as obeying legal requirements, ending age discrimination in health and social care requires a change in hearts and minds towards encouraging society to think differently about the ways in which older people are supported by health and social care services. Originality/value – Since the review, there have been repeated cases of age discrimination in goods and services, illustrating the need for change. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore potential benefits in aligning Joint Strategic Needs Assessments (JSNAs) with implementation of the Equality Delivery System (EDS) to improve commissioning of healthcare for minority ethnic groups. Design/methodology/approach – The paper draws on data gathered for a large research study carried out in England exploring the use of evidence in commissioning for multi-ethnic populations, to present a reflective discussion on the potential synergies between JSNA and EDS processes. Qualitative data were collected from 62 interviews with stakeholders in Sheffield, Leeds and Bradford, who, as part of their normal role, had an active responsibility to contribute to decision making for commissioning healthcare. 19 individuals working in national roles with experience in evidence use, ethnicity and commissioning across NHS, local authorities and third sector were also interviewed. Observational data were collected through regular attendance at an NHS Equality Group, which had Equality Delivery System implementation within its remit, and from a regional workshop focussing on Joint Strategic Needs Assessment improvements. Observations also came via participation in local EDS implementation meetings across Sheffield, Leeds and Bradford. These data were supplemented by a review of local and national policy literature about implementing JSNA and EDS. Findings – Formally strengthening the connection between JSNAs and the EDS has potential benefits for enhancing the evidence base about health and wellbeing needs of minority groups in general, and ethnic minorities in particular. Originality/value – NHS and Local Authority organisations need to establish structural processes to formally connect these two workstreams and to ensure adequate resource is made available, with clear direction from senior management. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of the paper is to provide an overview of issues being faced, and likely to have to be faced, in establishing effective health and wellbeing boards. Design/methodology/approach – The paper is based the perspective of the Department of Health's lead for implementation of these boards. Set in the context of national policy expectation, it draws on the early experiences of board development all over the country; and on discussions and seminars held to test their practical implications. Findings – Transformation of the current pattern of services is needed to meet the preferred needs of the public. This is a major challenge at local level, and the leadership capacity and style of the new boards, and their communication skill, will be vital to the creation of responsive integrated services. Originality/value – The paper draws together current thinking on a key policy initiative of the current government, and links it directly to integrated health and social care. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to examine the role of health and wellbeing boards in the context of the Government's reforms introduced by the Health and Social Act 2012 and the fundamental challenges facing the NHS and local government; it also aims to assess evidence from the early experience of shadow boards and considers what factors will most influence their success. Design/methodology/approach – The paper draws on an analysis of the policy literature and on structured telephone interviews with lead representatives of 50 health and wellbeing boards randomly selected from a representative cross section of English local authorities; it also draws on case study material, some of which has been written up for other articles in this Special Issue. Findings – Early experience of the boards in shadow form indicates there is considerable optimism about their prospects to achieve greater success in achieving integrated services but they face formidable challenges arising from a hostile financial climate and unchanged national policy fault lines that have hindered effective integration to date. Poor engagement with providers will limit progress. Five factors that are likely to determine the effectiveness of boards are identified. Their biggest single challenge arises from the role of local government in delivering strong, credible and shared leadership which engages people in transforming local services. Research limitations/implications – Current knowledge is based on the operation of shadow boards at a very early stage in their development and in the context of complex organisational change in which there is major uncertainty about emerging roles of new bodies. Originality/value – There is very little systematic research evidence about the development of health and wellbeing boards other than the work reported in this paper, illustrated by the linked articles which follow it. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The paper examines government IT outsourcing polices. The paper critiques the concept of ‘the Contract State’, and suggests how more disciplined uses of outsourcing can assist the creation of public value, more broadly conceived. Within the context of international developments, we study the United Kingdom Inland Revenue (IR), Customs and Excise (HMRC) and Department of Social Security (DSS) and their IT outsourcing contracts. The evidence suggests that outsourcing and marketization initiatives have adverse public value impacts, and may need to be rethought. Major IT operations and innovations, for example e-government, National Health Service (NHS) and identity card IT policies in the UK, are managed and generate legacies that do not always make efficient and effective use of the market. Moreover, their objectives, implementation and management over time may truncate their value to the public at large. Applying a revised Public Value policy approach offers a richer perspective to guide central government decisions worldwide about future IT outsourcing. [Copyright &y& Elsevier]

Abstract: The paper aims to identify the main drivers of innovation in the hospital sector. It further explores the mechanisms shaping how open hospitals are to external collaboration towards innovation. The paper pulls together data on organizational flexibility and innovation from 95 hospitals from the public sector in Portugal, collected through a survey and interviews to hospital boards. The main findings suggest that external cooperation is the major driver of innovation, while technology is rather seen as an enabler of innovation in hospitals. Results also highlight knowledge management, trust building, communication and focus on the user as the major mechanisms for opening up innovation. Within the context of open innovation, hospitals jointly with other health services, universities and users have the opportunity to shape policy and practice to accelerate innovation. Incentives are needed to drive systemic and cultural changes, as well as to establish a common platform for external. [Copyright &y& Elsevier]

farquharson b., allan j., johnston d., johnston m., choudhary c. & jones m. (2012) Stress amongst nurses working in a healthcare telephone-advice service: relationship with job satisfaction, intention to leave, sickness absence, and performance. Journal of Advanced Nursing 68(7), 1624-1635. Abstract Aims. This paper is a report of a study, which assessed levels of stress amongst nurses working in a healthcare telephone-advice service. We explored whether stress related to performance, sickness absence, and intention to leave. Background. Nurses report high levels of stress, as do call-centre workers. The emergence of telephone health advice services means many nurses now work in call-centres, doing work that differs markedly from traditional nursing roles. Stress associated with these roles could have implications for nurses, patients, and service provision. Design. This paper reports cross-sectional survey results. The design of the overall study included longitudinal elements. Method. A comprehensive study of stress was conducted amongst nurses working for a telephone-advice service in Scotland (2008-2010). All nurse-advisors were approached by letter and invited to participate. A total of 152 participants (33%) completed a questionnaire including General Health Questionnaire-12, Work Family Conflict Questionnaire, Job Satisfaction Scale and a measure of intention to leave the telephone-advice service and rated the perceived stress of 2 working shifts. Nurses' employers provided data on sickness absence and performance. Results. Overall levels of psychological distress were similar to those found amongst Scottish women generally. In multiple regression, work-family conflict was identified as a significant predictor of job satisfaction and intention to leave, and significantly related to sickness absence. There were significant correlations between General Health Questionnaire scores and perceived stress of shifts and some performance measures. Conclusions. Work-family conflict is a significant predictor of job satisfaction, intention to leave, and sickness absence amongst telephone helpline nurses. Minimizing the impact of nurses' work on their home lives might reduce turnover and sickness absence. [ABSTRACT FROM AUTHOR]

Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery. [ABSTRACT FROM AUTHOR]

Purpose – In April 2010, Nottinghamshire Healthcare NHS trust won Regional Innovation Funding to recruit, train and employ six peer support workers in community mental health teams. At the time, practical examples of the employment of peer support workers were lacking in England. The aim of this paper is to communicate the key lessons learned in this first year of peer support in the hope that these will provide a foundation for other services to build upon. Design/methodology/approach – The project was evaluated using a simple evaluation model reflecting service structure, processes and outcomes, collected through qualitative methods: documentary analysis, semi-structured interviews and a focus group. Findings – The peer support employment process has been broken down into its fundamental components (selection, recruitment, training, supervision relationships, recovery approach and discharge of clients) and within each of these sections a brief narrative is provided to explain some of the challenges faced. Each section ends with recommendations based on the lessons learned as a result of the pilot study. Research limitations/implications – A second paper will examine the nature of peer support: what the peers did with clients and what difference this made. Originality/value – At present many mental health services are planning to employ peer support workers and this paper provides some early guidance for implementing this process in the NHS. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore the extensive roots of peer support in mental health, and to identify the values and principles that the authors wish to hold onto as choices are made as to how and whether to engage with formal peer support within the National Health Service (NHS). Design/methodology/approach – The authors attempt to cover the ground of three types of peer support, but with an emphasis on informal peer support and participation in consumer or peer-run groups as providing the roots for the third more formal type, which is often known as intentional peer support (IPS). Findings – Professionalisation of peer support may endanger the equality that lies at the root of peer support relationships. Independence may also be compromised if peer support becomes just another part of mainstream services. Whilst an individual/personalised approach to providing services has many strengths, one must be careful not to remove all opportunity for service users to meet together, support one another, plan and campaign. Practical implications – The findings suggest that commissioners of services should aim for a plurality of peer support and be careful to ensure that informal peer support is flourishing as an essential basis for more formal peer support. Originality/value – The paper shows that, with an increased interest in providing peer support as part of mainstream services, it is important to stress the basic values and principles that underpin informal service-user led peer support. [ABSTRACT FROM AUTHOR]

Purpose – In April 2010, Nottinghamshire Healthcare NHS trust won Regional Innovation Funding to recruit, train and employ six peer support workers in community mental health teams. At the time, practical examples of the employment of peer support workers were lacking in England. An earlier paper focuses on the lessons learned in this first year of peer support. The aim of this paper is to examine the nature and dynamics of peer support: what the peers did with clients and what difference this made. Design/methodology/approach – The project was evaluated using a simple evaluation model reflecting service structure, processes and outcomes, collected through qualitative methods: documentary analysis, semi-structured interviews and a focus group. Findings – The six peers worked with 83 clients over the six month period. They offered emotional, practical, social support, support specific to care and support specific to recovery. They felt that the shared knowledge that they too had experienced mental health challenges was critical in engaging with clients in a trusting relationship and in informing their work. Originality/value – In the absence of English service models for peer support workers, this paper provides some guidance for new peer support teams, and some evidence to support the helpful nature of peer support work. [ABSTRACT FROM AUTHOR]

Issue addressed: Nillumbik Shire Council, in partnership with La Trobe University, used the Municipal Public Health Planning process to develop an approach for building the resilience of local communities to climate-related stressors. The objective was to define an approach for building community resilience to climate change and to integrate this approach with the 'Environments for Health' framework. Methods: Key published papers and reports by leading experts the field were reviewed. Literature was selected based on its relevance to the subjects of community resilience and climate change and was derived from local and international publications, the vast majority published within the past two decades. Results: Review of literature on community resilience revealed that four principal resource sets contribute to the capacity of communities to adapt in times of stress, these being: economic development; social capital; information and communication; and community competence. On the strength of findings, a framework for building each resilience resource set within each of the Environments for Health was constructed. This paper introduces the newly constructed 'Community Resilience Framework', which describes how each one of the four resilience resource sets can be developed within social, built, natural and economic environments. Conclusion: The Community Resilience Framework defines an approach for simultaneously creating supportive environments for health and increasing community capacity for adaptation to climate-related stressors. As such, it can be used by Municipal Public Health Planners as a guide in building community resilience to climate change. [ABSTRACT FROM AUTHOR]

This paper outlines the history of workforce strategies for providing mental health care to “black and ethnic minorities” in England. Universal mental health policies failed to deliver equity in care, and thus specific policies were launched to address ethnic inequalities in care experiences and outcomes. The emphasis on race equality rather than cultural complexity led to widespread acceptance of the need for change. The policy implementation was delivered in accord with multiple regional and national narratives of how to reduce inequalities. As changes in clinical practice and services were encouraged, resistance emerged in various forms from clinicians and policy leaders. In the absence of commitment and then dispute about forms of evidence, divergent policy and clinical narratives fuelled a shift of attention away from services to silence issues of race equality. The process itself represents a defence against the pain of acknowledging systemic inequities whilst rebutting perceived criticism. We draw on historical, psychoanalytic, and learning theory in order to understand these processes and the multiple narratives that compete for dominance. The place of race, ethnicity, and culture in history and their representation in unconscious and conscious thought are investigated to reveal why cultural competence training is not simply an educational intervention. Tackling inequities requires personal development and the emergence and containment of primitive anxieties, hostilities, and fears. In this paper we describe the experience in England of moving from narratives of cultural sensitivity and cultural competence, to race equality and cultural capability, and ultimately to cultural consultation as a process. Given the need to apprehend narratives in care practice, especially at times of disputed evidence, cultural consultation processes may be an appropriate paradigm to address intersectional inequalities. [ABSTRACT FROM PUBLISHER]

The National Health Service (NHS) in England is facing significant challenges ahead as a result of the government’s plans to reduce national debt. The challenge for infection control practitioners will be to continue to support the development and delivery of high quality clinical services without the level of funding previously experienced over the last decade. In order to achieve this all healthcare professionals will be required to embrace improvement strategies. The purpose of this paper is therefore to report on a review of a clinical reporting and root cause analysis (CRRCA) process coordinated by a community-based infection prevention and control team. The paper outlines the issues surrounding the current CRRCA process and analyses the process using lean concepts. A series of change options are put forward in order to illustrate how a failure to effectively scope improvement project boundaries can constrain change thereby limiting the potential for productivity and quality improvement. [ABSTRACT FROM PUBLISHER]

Health services continue to be seen as significant settings for health improvement, and developments continue to be made in the nature of such work, means of optimal delivery and outcomes. This paper builds on previous work by reporting on activity in a series of sites within ‘NHS Health Scotland's (NHS HS)’ Health Promoting Health Service (HPHS) initiative. The objectives of the review were to: describe the achievements of HPHS sites, assess the degree of influence and embedding of the HPHS approach, review the support functions provided by ‘NHS HS' and identify the challenges to implementation and sustainability. The review identified a variety of activity associated with HPHS, ranging from a topic focused/behaviour change approach to efforts to re-orientate organizational features. The role that NHS HS played in developing settings capacity was largely endorsed, and there was, despite the existence of some barriers, evidence that HPHS was being successfully embedded within health service organizational policies and procedures. In particular, the role of a national level strategic guidance document to NHS CEOs [‘Chief Executive Letter (14)'] is noted as having been significant in creating a conducive context for HPHS. In this context, the paper concludes by reflecting more broadly on the current status of settings-based health improvement and suggests that on the basis of this review there should be optimism in pursuing a relatively expansive vision of health improvement in this particular setting and potentially others. [ABSTRACT FROM AUTHOR]

The National Health Service (NHS) Estate in England comprises more than 30 Mm2 with 18.83 Mm2 of acute hospital accommodation on 330 sites. There is concern about the resilience of these buildings in a changing climate, informed by the experience of recent heatwaves. However, the widespread installation of air conditioning would disrupt the achievement of ambitious energy reduction targets. The research project ‘Design and Delivery of Robust Hospital Environments in a Changing Climate’ is attempting to estimate the resilience of the NHS Estate on the basis of current and projected performance, using an adaptive comfort model. This paper presents results relating to a 1920s traditionally built block with open ‘Nightingale’ wards, a representative type. The paper demonstrates the relative resilience of the type, and illustrates a series of light-touch measures that may increase resilience while saving energy.Practical application: The results presented in this paper will be of value to NHS Trusts: Estates staff charged with operating buildings as well as Boards and others involved in decision-making. It will also find an audience with policymakers in central government and the Department of Health, as well as those who own, operate or are tasked with working on non-domestic buildings with heavy traditional construction. [ABSTRACT FROM PUBLISHER]

Purpose – This paper seeks to address the issue of contemporary vulnerabilities in the context of late capitalism, analysing how policy making directed at the public health system in Brazil has targeted groups that are made visible from an exclusion perspective, whether by their sexual, ethnic, geographic or gender identities. Design/methodology/approach – The paper analyses the array of public policies behind the construction and development of the Brazilian Unified Healthcare System, confronting them with ethnographic research of practices of care in health services. Findings – The themes of vulnerability and health are being worked upon within the public health system in Brazil as forms of "inclusion": discrimination and prejudice are considered one of the aspects of health vulnerability. Government health policies are supporting projects, seminars and methods of facilitating social movements' expression, and also concrete actions towards denouncement of discrimination, which has been criminalized. However, contemporary public health is also a new normative field adapted to the neoliberal market, where risks are individualized and individuals are held responsible for what they do with their bodies. Originality/value – The focus on both governmental policies and practices of public healthcare in the Brazilian context, highlighting the complexities of the application of risk and vulnerability discourses will be informative not only to scholars in the field of public health, but to practitioners and policy makers alike. [ABSTRACT FROM AUTHOR]

This paper suggests that there is an imbalance between the ideal and the actual palliative care provision for some older people living and dying in care homes in Scotland. Successive studies demonstrate that care home residents are increasingly frail and disabled. Many experience challenging physical and psychosocial symptoms which could benefit from a palliative approach to alleviate suffering and promote comfort. However, palliative needs for people with non-malignant conditions, such as dementia, can be complex, and not easily identified or managed. A range of challenging factors currently impact palliative care provision for care home residents in Scotland including: the insufficiency of robust NHS healthcare support, the skill mix of the care home workforce, and the promotion of palliative tools as the primary means of improving the quality of palliative care in nonspecialist settings. Issues highlighted in this paper give cause for concern on a number of levels, particularly as the demand for palliative care in care homes is likely to increase in the near future. Therefore, sustained collaborative effort from leaders in the health, social and care home sectors is recommended if practical solutions are to be found for this vulnerable population. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to describe the origins of the concept of a psychologically informed environment (PIE), as now adopted and applied in homelessness resettlement, placing this in the context of work recently carried out under the aegis of the Royal College of Psychiatrists' Centre for Quality Improvement to recognise and promote "enabling environments" in all areas of social practice. Design/methodology/approach – This paper gives an historical account of the contemporary development of new thinking and practical applications for enhancing community mental health and well-being. Findings – The concept of an enabling environment (EE) arose out of efforts to up-date for the twenty-first century the post-war concept of a therapeutic community, for all services working with the same basic core values and psycho-social awareness. The EE approach now applies this framework more flexibly, yet with a clear operational focus in each sector, to a wider range of organisational contexts, social practice and agencies outside the therapy and care services world. From the outset, homelessness resettlement and social housing practice was seen as a key part of the overall ambition. Practical implications – Understanding the values base behind social-psychological approaches in social practice environments helps to translate these ideas into service-led improvements in actual frontline services practice. In particular, the enabling environments approach offers a handy tool for self-assessment and service improvement, which is fully compatible with the PIE's philosophy. Originality/value – The concept of a PIE is currently acquiring momentum within homelessness resettlement work in the UK. In helping to establish the underlying values framework for psychologically-informed services; and also provide tools for such services to use, this paper makes a contribution to help inform developing practice. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to ascertain the training status of staff in care homes for people with intellectual disabilities managed by the non-health sector in High Wycombe, with regard to administering emergency antiepileptic medication and to identify training needs. Design/methodology/approach – Management of seizures in people with intellectual disabilities and epilepsy comes with its challenges. Although there are clear guidelines for the same, implementing them in the community, especially in the non-health sector setting, raises the issue of training staff in the administration of emergency antiepileptic medication. A survey was undertaken in response to the varying staff training needs. A short semi-structured questionnaire was designed and administered over the telephone to the managers of these care homes. Findings – Less than half of the care homes had staff trained to administer emergency antiepileptic medication. The commonest reason cited was their policy of admitting only patients with well controlled seizures. This paper identified the need for staff training and raising awareness amongst relevant healthcare professionals. Practical implications – The survey highlights the practical difficulties arising in the implementation of national and trust level healthcare policies in the community. Originality/value – This paper is of value to clinicians working with people with intellectual disabilities and epilepsy, GPs, and staff and management in the care homes in the health and non-health sectors. It raises questions around delineation of responsibility and communication between various professionals in various levels of care involved in managing people with intellectual disabilities and epilepsy to ensure provision of safe and effective care for this population. [ABSTRACT FROM AUTHOR]

Background: Pharmacists working in community and primary care are increasingly developing advanced skills to provide enhanced services, particularly in dealing with minor acute illness. These services can potentially free-up primary care physicians' time; however, it is not clear whether they are sufficiently cost effective to be recommended for wider provision in the UK.Objective: The aim of this study was to review published economic evaluations of enhanced pharmacy services in the community and primary care settings.Methods: We undertook a systematic review of economic evaluations of enhanced pharmacy services to inform NICE guidelines for emergency and acute care. The review protocol was developed and agreed with the guideline committee. The National Health Service Economic Evaluation Database, Health Technology Assessment Database, Health Economic Evaluations Database, MEDLINE and EMBASE were searched in December 2016 and the search was updated in March 2018. Studies were assessed for applicability and methodological quality using the NICE Economic Evaluation Checklist.Results: Of 3124 records, 13 studies published in 14 papers were included. The studies were conducted in the UK, Spain, The Netherlands, Australia, Italy and Canada. Settings included community pharmacies, primary care/general practice surgeries and patients' homes. Most of the studies were assessed as partially applicable with potentially serious limitations. Services provided in community and primary care settings were found to be either dominant or cost effective, at a £20,000 per quality-adjusted life-year threshold, compared with usual care. Those delivered in the patient's home were not found to be cost effective.Conclusions: Advanced pharmacy services appear to be cost effective when delivered in community and primary care settings, but not in domiciliary settings. Expansion in the provision of these services in community and primary care can be recommended for wider implementation. [ABSTRACT FROM AUTHOR]

Purpose: Applications for clinical psychology training far outstrip places and relevant work experience is key. Paid opportunities are limited and therefore many choose volunteering, with well-connected graduates faring best. To promote equal opportunities a coordinated psychology graduate voluntary internship programme was established in a National Health Service Trust in the South of England. The purpose of this paper is to evaluate intern and supervisor outcomes, equality of access and adherence to governance standards. Design/methodology/approach: Three cohorts of interns, unappointed applicants and supervisors were surveyed. Between 2013 and 2016, 270 psychology graduates applied, 119 were recruited and 151 either refused a place or were unsuccessful. In total, 91 supervisors provided service-level feedback. Findings: Interns and applicants were predominantly young, able-bodied white British heterosexual females. Demographic profiles were similar and broadly representative of psychology graduates nationally. While fewer were from Black and Ethnic Minority backgrounds, proportions were greater than the local population. Participants were more socioeconomically privileged than undergraduates nationally. The scheme was popular and well governed according to interns and supervisors. Post-internship employment prospects were improved, with most interns gaining paid mental health roles like assistant psychologist. Most supervisors commented on the positive contribution made by interns to service outcomes. Originality/value: This study makes a significant contribution to the literature on voluntary psychology graduate posts, an area under-researched until now. Our results suggest that a coordinated, transparent approach can benefit both interns and services by minimising exploitation and maximising developmental opportunities for the new graduate. The programme makes an important contribution to addressing inequalities experienced by psychology graduates attempting to enter mental health careers. [ABSTRACT FROM AUTHOR]

Purpose: Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach: An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings: Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the "common-language" created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value: WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives. [ABSTRACT FROM AUTHOR]