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Purpose: The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory framework in England. Design/methodology/approach: In reviewing the three research papers, developments and points of continuity in the field of self-neglect were identified and are discussed in this paper. Findings: In light of the findings of the three articles, the present paper traces some of the classificatory refinements in this field that have taken place since the papers were published, notably in respect of hoarding and severe domestic squalor. Some of the difficulties in making judgements about behaviour thought to breach societal norms are described, and the challenges practitioners face in intervening in cases, particularly where the person concerned is refusing assistance, are examined. Originality/value: By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect. [ABSTRACT FROM AUTHOR]

Aim: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Design: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Methods: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Results: Participants continued to deliver a significant proportion of patient care inperson. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. Conclusion: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. Impact: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Reporting method: Standards for Reporting Qualitative Research (O'Brien et al., 2014). Patient or public contribution: This was a workforce study so there was no patient or public contribution. Implications for the profession and patient care: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward. [ABSTRACT FROM AUTHOR]

Background: Palliative care is insufficiently integrated in the continuum of care for older people. It is unclear to what extent healthcare policy for older people includes elements of palliative care and thus supports its integration. Aim: (1) To develop a reference framework for identifying palliative care contents in policy documents; (2) to determine inclusion of palliative care in public policy documents on healthcare for older people in 13 rapidly ageing countries. Design: Directed documentary analysis of public policy documents (legislation, policies/strategies, guidelines, white papers) on healthcare for older people. Using existing literature, we developed a reference framework and data extraction form assessing 10 criteria of palliative care inclusion. Country experts identified documents and extracted data. Setting: Austria, Belgium, Canada, Czech Republic, England, Japan, Mexico, Netherlands, New Zealand, Singapore, Slovenia, South Korea, Spain. Results: Of 139 identified documents, 50 met inclusion criteria. The most frequently addressed palliative care elements were coordination and continuity of care (12 countries), communication and care planning, care for family, and ethical and legal aspects (11 countries). Documents in 10 countries explicitly mentioned palliative care, nine addressed symptom management, eight mentioned end-of-life care, and five referred to existing palliative care strategies (out of nine that had them). Conclusions: Health care policies for older people need revising to include reference to end-of-life care and dying and ensure linkage to existing national or regional palliative care strategies. The strong policy focus on care coordination and continuity in policies for older people is an opportunity window for palliative care advocacy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to discuss the methodological challenges to evaluating one of the 50 vanguard sites of the new care model (NCM) programme for integrated care in England, and make the case for a modified realist approach to this kind of evaluation. Design/methodology/approach: The paper considers three challenges to evaluating the NCM in this particular vanguard: complexity, strategy and rhetoric. It reflects on how the realist approach negotiates these philosophical challenges to delivering integrated care, in order to provide contextualised accounts of who a programme works for, in what context, and why. Findings: The paper argues that, in the case of this particular vanguard site, the tangible benefit of the realist approach was not in providing a firm epistemological basis for evaluation, but rather in drawing out and articulating the ontological rhetoric of such large-scale transformation programmes. By understanding the work of the NCM less as an objective "system", and more as a dynamic form of persuasion, aimed at securing the "adherence of minds" (Perelman and Olbrechts-Tyteca, 2008, p. 8) in multiple audiences, the paper suggests that realist evaluation can be used to address both the systematic issues and localised successes the NCMs encountered. Originality/value: The paper identifies a number of aspects of new models of integrated care for evaluators to consider. It offers ways of negotiating the challenges to conventional outcome-focused evaluation, by drawing attention to the need for contextualised, time-situated and audience-sensitive value of NCMs. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present a mixed methods study of child criminal exploitation (CCE), particularly in the form of "county lines", in three local authorities in southeast England. The data is analysed using a framework constructed from two relevant contextual and relational theories to understand experiences of CCE and the safeguarding responses undertaken to protect young people from harm. Design/methodology/approach: Data were drawn from a survey (n = 118); interviews (n = 5) and focus groups (n = 15) with professionals; interviews with parents (n = 4); and from secondary analysis of eight interviews with young people affected by criminal exploitation. The analytic framework was applied to the data to answer two research questions: what is the role and significance of young people's interactions with peers, parents and professionals in their CCE trajectories; and how do professionals understand and address risks within contexts in which young people are exposed to CCE? The mixed methods data collected by the authors were coded and analysed using this framework. Findings: Although professionals were aware of contexts and relational power dynamics, the situated and temporal nature of CCE remained overlooked within safeguarding systems. Professionals required more space, time and support to fully and flexibly engage with young people and their families to increase safety. Originality/value: There is limited research available that critically examines safeguarding responses to CCE in diverse geographic and cultural contexts. This paper contributes a critical account of how professionals might create connections and opportunities for change with young people, identifying structural constraints within practice systems alongside emerging examples of effective practice. [ABSTRACT FROM AUTHOR]

Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. Aims: To compare the impact of standard parent‐based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent‐based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20‐week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non‐standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM‐SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well‐being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. Outcomes and Results: One hundred fifty‐five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur‐Bates Communicative Development Inventories Sentence Length, from pre‐intervention to post‐intervention and 6 months post‐intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval –0.02 to 0.76), although wide variation was found. Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject: Speech, language and communication needs (SLCN) have a knock‐on effect on emotional well‐being, school readiness, literacy and school attainment, putting children at increased risk of long‐term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge: Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work?: This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes. [ABSTRACT FROM AUTHOR]

Meeting individuals' social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of 'unmet need' remain a challenge. This paper advances our understanding by incorporating a temporal dimension into the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 8 and 9 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (a) no longer having such a need; (b) having continued needs met; (c) delayed needs met; (d) newly arisen unmet needs; and (e) repeated unmet needs. The results indicate that amongst those with need at baseline, unmet need has decreased over time – indicating that some needs for social care may be fulfilled with a delay. However, a significant proportion of older people experienced repeated unmet needs, particularly those who were younger, with no spouse or civil partner, and those whose activities of daily living index scores worsened over time. Understanding the dynamics of unmet need can support policy makers in better ensuring that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [ABSTRACT FROM AUTHOR]

Safeguarding for healthcare involves working together to protect adults, children, and young people at risk of harm. Despite global research and national guidance outlining health professionals' roles in this regard, there is limited knowledge about the type of strategies used to mobilise safeguarding research to practitioners in England. Our critical interpretive synthesis (CIS) sought to explore how safeguarding knowledge is mobilised to enable practitioners to use research effectively. This synthesis aimed to bridge the theory-practice gap in mobilising safeguarding knowledge to practitioners. Knowledge mobilisation (KMb) is an emerging discipline concerned with moving knowledge across communities to catalyse change. This review aimed to build understanding about how safeguarding knowledge is mobilised for healthcare in England and to synthesise the type of approaches undertaken to protect adults and children from harms, including abuse. A critical interpretive synthesis was undertaken using KMb theory and computer-assisted modelling technologies for secondary thematic analysis of complex literature of relevance, including qualitative research, reviews, and reports. Few papers informed how safeguarding knowledge is mobilised for healthcare in England. Learning from experience dominated the literature in three ways: (i) crisis response, (ii) practice engagement, and (iii) influencing actions (for "best" practice). Embedding safeguarding knowledge and skills in healthcare settings usually followed a crisis response. Learning from experience showed movement between practice engagement and influencing actions for adult and/or child protection. KMb might be useful in supporting the implementation of evidence-based safeguarding for practice. CIS identified a gap in how safeguarding research is mobilised to practitioners for healthcare. KMb theory provided an analytical bridge to computer-assisted modelling of factors associated with moving learning from experience to learning in practice. Future research could build on hybrid synthesising of safeguarding functions and impacts for healthcare, to enable practitioners to protect adults and children from multiple harms, including violence and abuse. [ABSTRACT FROM AUTHOR]

User participation has become one of the most important concepts in the social care sector in many European countries, but the literature has mostly paid attention to disabled people or those with mental health problems. This article compares the user participation policies directed at social care for older people in Norway and England. Using a discourse analytical approach, a selection primarily of White papers from the 1960s until today are analysed. The analysis draws on the literature's discourse discussion, including a democratic/rights based discourse (full citizenship), a consumer discourse (consumers' rights to choose welfare services), a co-production discourse (users and state/local authorities partnerships), and nuances of these discourses. The analysis shows that, while both countries start with variations of a democratic discourse, Norway develops a temporary and weak consumer discourse in a middle phase, then moves to co-production in current times. England, on the other hand, develops a comprehensive consumer discourse but also a surprisingly strong co-production discourse – the idea of a 'Big Society' – in early and current times. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine how faculty staff on health and social care programmes support students with mental health issues. Design/methodology/approach: The study used a qualitative survey design to gain in-depth information on faculty staff experiences. Seventy-one faculty staff at two universities in the South East of England out of an eligible population of 115 staff responded to an anonymous online questionnaire which were thematically analysed. Findings: The findings indicated that faculty staff faced uncertainties in providing support to students with mental health needs. They reported tensions between their academic, professional and pastoral roles. There was a wide recognition that supporting students was physically and emotionally demanding for faculty staff and especially challenging when their roles and expectations were unclear. This was compounded by lack of explicit guidelines and an apparent severed connection between faculty staff and student support services. Practical implications: A need for clearly defined roles and responsibilities for faculty staff in supporting students with mental health needs including a review of their pastoral role were identified. The study reinforces the need for effective collaborative arrangements and collective decision making and clearer procedures in the planning and implementation of students' personal support plans. A concerted effort into adopting a transpersonal approach which incorporates mental health staff awareness training, restorative spaces for reflection and supportive pathways for faculty staff are recommended. Originality/value: This paper provides rare empirical evidence of faculty staff views on their role in supporting students with mental health needs on health and social care programmes. [ABSTRACT FROM AUTHOR]

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

This paper presents findings from a study of family literacy provision in England and focuses on the effects of family literacy programmes on the home literacy environment. The fieldwork took place between September 2013 and December 2014 and involved 27 school-based programmes for pupils aged between 5 and 7, and their parents. The study used mixed methods, which involved observations of family literary sessions, a quantitative pre- and post-survey of 118 parents, and pre- and post-telephone qualitative interviews with a sub-sample of 24 parents. Building on previous theoretical work, the study conceptualises the home literacy environment into four areas (family resources; parental literacy behaviours and attitudes; parental beliefs and understandings; and family literacy activities and practices). The paper develops understandings of how parents translate and implement messages from family literacy into the home setting, and it shows how participation in these programmes leads to changes in family literacies across all four areas identified. [ABSTRACT FROM AUTHOR]

This paper aims to explore how social work students can support lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) young people in schools. Drawing on the reflective practice portfolio documents of four students who worked with LGBTQ+ young people in a school as part of a social workers in school (SWIS) student placement project, the article uses thematic analysis to identify how the students were able to support young people identifying as LGBTQ+. The article subscribes to a poststructuralist theoretical framework which sees gender and sexual identities as multiple, fragmented and constructed in relation to others and within the systems of knowledge and power that exist in schools. The article demonstrates the benefit to schools of having social work students on practice placement. The students' own reflections critically contemplate the way in which they were able to spend more prolonged periods of time with young people than the teachers could, both with individuals and LGBTQ+ groups. The students' reflective portfolios show the value of the school placements to their own development of knowledge and skills [ABSTRACT FROM AUTHOR]

Teachers in Lady Agatha's Boarding School (Lady Agatha's) find teaching Sex and Relationships Education (RSE) uncomfortable. This paper investigates one aspect of the discomfort that they feel, namely the impact RSE has on their professional status as teachers. I use focus group data to reflect on the professional and personal location of teachers at Lady Agatha's and to explore their understanding of RSE through the recurring themes of professionalism and professional reputation as symbolic capital; deprofessionalisation and risk as symbolic violence; and the connects and disconnects between the doxa and illusio of the school. Findings suggest that by interrogating the sites of symbolic violence which generate RSE discomfort, we can start to unpick the fabric which creates discomfort about RSE, allowing both for a deeper understanding of RSE discomfort in teachers and an opportunity to address this discomfort as a barrier to RSE delivery at Lady Agatha's. [ABSTRACT FROM AUTHOR]

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

Community participation is a central concept for health promotion, covering a breadth of approaches, purposes and activities. This paper reports on a national knowledge translation project in England, UK, which resulted in a conceptual framework and typology of community-based approaches, published as national guidance. A key objective was to develop a conceptual framework linked to sources of evidence that could be used to support increased uptake of participatory methods across the health system. It was recognized that legitimacy of community participation was being undermined by a scattered evidence base, absence of a common terminology and low visibility of community practice. A scoping review, combined with stakeholder consultation, was undertaken and 168 review and conceptual publications were identified and a map produced. A 'family of community-centred approaches for health and wellbeing' was then produced as way of organizing the evidence and visually representing the range of intervention types. There are four main groups, with sub-categories: (i) strengthening communities, (ii) volunteer and peer roles, (iii) collaborations and partnerships and (iv) access to community resources. Each group is differentiated using key concepts and theoretical justifications around increasing equity, control and social connectedness. An open access bibliography is available to accompany the framework. The paper discusses the application of the family of community-centred approaches as a flexible planning tool for health promotion practice and its potential to be used as a framework for organizing and synthesizing evidence from a range of participatory methods. [ABSTRACT FROM AUTHOR]

As a key driving force in adult social care policy in both the United Kingdom and internationally personalisation has wide-ranging implications for the social work profession. Yet its meaning can be elusive and is often contested. This article explores findings from a doctoral study which sought to explore the current meanings associated with the notion of personalisation, by asking those with lived experience how it is experienced by them. Unique features of the study's participatory and psychosocial research design, which placed lived experience at its centre, are outlined. Original findings from the study explored in this paper include a range of themes related to dependence, independence and interdependence, depersonalisation and reciprocity. Risks associated with contemporary practice models in adult social work, including strengths-based approaches are explored. Based on the findings a reorientation towards 'contribution-focused practice' within a relationship-based practice model is proposed. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to demonstrate the approach taken in delivering the quality and impact elements of Knowledge for Healthcare, the strategic development framework for National Health Service (NHS) library and knowledge services in England. It examines the work undertaken to enhance quality and demonstrate the value and impact of health library and knowledge services. It describes the interventions developed and implemented over a five-year period 2015–2020 and the move towards an outcome rather than process approach to impact and quality. Design/methodology/approach: The case study illustrates a range of interventions that have been developed, including the outcomes of implementation to date. The methodology behind each intervention is informed by the evidence base and includes professional engagement. Findings: The outcomes approach to the development and implementation of quality and impact interventions and assets provides evidence to demonstrate the value of library and knowledge staff to the NHS in England to both high-level decision-makers and service users. Originality/value: The interventions are original concepts developed within the NHS to demonstrate system-wide impacts and change. The Evaluation Framework has been developed based on the impact planning and assessment (IPA) methodology. The interventions can be applied to other healthcare systems, and the generic learning is transferable to other library and knowledge sectors, such as higher education. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present an analysis of a "county lines" safeguarding partnership in a large city region of England. A critical analysis of current literature and practice responses to "county lines" is followed by the presentation of an analytical framework that draws on three contextual and social theories of (child) harm. This framework is applied to the partnership work to ask: are the interconnected conditions of criminal exploitation of children via "county lines" understood?; do interventions target the contexts of harm?; and is social and institutional harm acknowledged and addressed? Design/methodology/approach: The analytical framework is applied to a data set collected by the author throughout a two-year study of the "county lines" partnership. Qualitative data collected by the author and quantitative data published by the partnership are coded and thematically analysed in NVivo against the analytic framework. Findings: Critical tensions are surfaced in the praxis of multi-agency, child welfare responses to "county lines" affected young people. Generalising these findings to the child welfare sector at large, it is proposed that the contextual dynamics of child harm via "county lines" must be understood in a broader sense, including how multi-agency child welfare practices contribute to the harm experienced by young people. Originality/value: There are limited peer-reviewed analyses of child welfare responses to "county lines". This paper contributes to that limited scholarship, extending the analysis by adopting a critical analytic framework to a regional county lines partnership at the juncture of future national, child welfare responses to "county lines". [ABSTRACT FROM AUTHOR]

Purpose - Service users very often interpret and respond to their experiences of death, dying and bereavement through a religious or spiritual lens. However, recent trends in religion and belief have influenced how professionals respond to indicators such as faith. Since the post-war years in Britain and due to the transfer of services from church to state, as well as the change in the religious landscape, language has largely secularized. When people start addressing religion and belief again, they lack the appropriate literacy to do so, this is termed religious literacy by Dinham (2015). The purpose of this paper is to explore how professionals in end of life (EOL) care respond to service user's religious and spiritual indicators, through the lens of religious literacy. Design/methodology/approach - The paper draws from an ethnographic study undertaken across hospices in England, UK. In this study, healthcare professionals (HCPs) were observed for one calendar year. Findings - Results show that lack of religious literacy on the part of HCPs may lead to subtle and unintentional microaggression. Three types of indications of microinvalidation have been noted: verbal, non-verbal and environmental. Originality/value - This paper innovates in offering a first-hand phenomenological interpretation of observations in the field. The research data capture visually the impact of lack of religious literacy, an achievement which adds to the dialogue about service user rights in EOL care. [ABSTRACT FROM AUTHOR]

Despite years of calls for adoption of a Just Culture, it is evident that taking this concept from paper to practice has been slower than expected. Many have cited the subpar application of the Just Culture framework and, recently, questions have been raised regarding how the Just Culture framework is perceived by those impacted by harm, including patients, family members, and staff. Though this framework is one tool that can be used to guide inquiry after harm events, its use, independent of active efforts toward restoration of relationships with patients, families, and staff, could compromise engagement and therefore learning. A lack of focus on restoring the trust of those affected by harm in parallel with the event investigation introduces a risk of further compounding the harm for all involved. Those involved in safety work at NHS England have recognized the need to apply a systems mindset within a concerted effort toward more compassionate engagement for optimal learning and improvement. In response, they have included compassionate engagement and involvement of those affected by patient safety incidents as a foundational pillar in the NHS England Patient Safety Incident Response Framework. [ABSTRACT FROM AUTHOR]

Social care Personal Assistants (PAs) are directly employed by individuals to assist with activities of daily living such as help or support with personal care, shopping, household tasks and community participation. This option is encouraged by UK public funding. In England, disabled people's support organisations initially offered assistance with such arrangements, although numbers doing this have declined. The Covid‐19 pandemic provided the opportunity to ask those remaining organisations providing support for PA employers about their activities during this time and the questions being posed to them by PA employers. This paper reports data from 15 interviews undertaken March–July 2021 with disability support organisation representatives. We identified one overarching theme 'Working to prevent and challenge marginalisation of PA employers', with three related subthemes: (1) Advocating for the voice of a forgotten group; (2) Needing to be proactive and (3) Adapting to new tasks and ways of working. Participant accounts focused on representing the needs of disabled people to the authorities and providing concise, timely and accurate information to PA employers, particularly around the use of public funds during Covid‐19. Remote working amplified the digital‐divide, resulting in these organisations working hard to ensure PA employers received important information about their support options. Befriending services and Covid‐hubs were established by some organisations to reduce isolation and risks of poor mental health amongst PA employers. Many of the challenges facing PA employers existed pre‐pandemic but were perceived to have been heightened during it, reflecting the value of and need for the work of these local support organisations. Our findings suggest areas where effective contingency planning drawn from closer collaboration between disability support organisations and central and local government might usefully be focussed. The potential for specific services or organisations to be commissioned to provide such support is discussed. [ABSTRACT FROM AUTHOR]

Background and context: Breastfeeding peer support is valued by women, but UK trials have not demonstrated efficacy. The ABA feasibility trial offered proactive peer support underpinned by behaviour change theory and an assets‐based approach to women having their first baby, regardless of feeding intention. This paper explores women's and infant feeding helpers' (IFHs) views of the different components of the ABA intervention. Setting and participants: Trained IFHs offered 50 women an antenatal meeting to discuss infant feeding and identify community assets in two English sites—one with a paid peer support service and the other volunteer‐led. Postnatally, daily contact was offered for the first 2 weeks, followed by less frequent contact until 5 months. Methods: Interviews with 21 women and focus groups/interviews with 13 IFHs were analysed using thematic and framework methods. Results: Five themes are reported highlighting that women talked positively about the antenatal meeting, mapping their network of support, receiving proactive contact from their IFH, keeping in touch using text messaging and access to local groups. The face‐to‐face antenatal visit facilitated regular text‐based communication both in pregnancy and in the early weeks after birth. Volunteer IFHs were supportive of and enthusiastic about the intervention, whereas some of the paid IFHs disliked some intervention components and struggled with the distances to travel to participants. Conclusions: This proactive community assets‐based approach with a woman‐centred focus was acceptable to women and IFHs and is a promising intervention warranting further research as to its effect on infant feeding outcomes. [ABSTRACT FROM AUTHOR]

Personal health budgets (PHBs) are being promoted in England as expanding the benefits of choice and control to individuals with healthcare needs. National Health Service (NHS) money is provided to eligible people to use as set out in approved care plans, including direct employment of personal assistants (PAs). The government plans to increase NHS‐funded PHBs and to further introduce integrated personal budgets (IPBs). This potentially creates more demand for directly employed or self‐employed PAs with health‐related skills. The objective of this paper is to report findings from interviews with PAs (n = 105) and key informants (n = 26) from across England, undertaken between October 2016 and August 2017, about the potential for the PA workforce to undertake 'health‐related' tasks as facilitated by the introduction of PHBs. PAs were purposefully recruited to ensure the sample included participants from different geographical locations. Key informants were purposefully selected based on their knowledge of policy and community services. Data were analysed quantitatively and qualitatively. This paper focuses on reporting qualitative findings, which are set within the theoretical framework of normalisation process theory to explore implementation challenges of PHBs. The majority (64%) of PAs confirmed that they saw their current roles as congruent with PHBs, were willing to engage with PHBs and undertake health‐related tasks. However, 74% of PAs said they would need additional training if enacting such roles. Key informant interviews appraised the development of PHBs as complex, noting incongruences arising from NHS and social care‐funded PAs carrying out similar roles within different organisational systems. We conclude the current PA workforce is willing to take on PHB work and is likely to interweave this with work funded by PBs and self‐funding care users. Implications include the need for careful consideration of training requirements and delivery for PHB‐funded PAs. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes. [ABSTRACT FROM AUTHOR]

Developing professional identity is a key aim of social work education. This paper argues that the Professional Capabilities Framework (PCF) – a holistic, capability approach to student assessment used in England’s social work education programmes – is ideally placed to promote the development of students’ professional identities. The paper discusses two research studies, each of which was stimulated by significant policy changes in England’s social work profession. The author draws out the implications of both studies for supporting social work students to develop their professional identities. It is concluded that the PCF is valued by practice educators as an assessment and teaching tool, while acknowledging that its future is uncertain due to the lack of continuity impacting on England’s social work profession. This paper is equally of relevance for social work educators outside the UK who may be developing and evaluating their assessment approaches and also for those experiencing the impact of rapid policy changes in their own countries. [ABSTRACT FROM AUTHOR]

Purpose The increased involvement of adults at risk in the safeguarding process has become a prominent issue within English safeguarding policy. However, there is evidence to suggest that actual levels of involvement are still low. The purpose of this paper is to present findings from a PhD study in relation to the benefits of advocacy in supporting this involvement in adult safeguarding for older people.Design/methodology/approach Participants in the study included advocates and social workers who had experience of working with older people through the safeguarding process within two North East England local authorities. A critical realist approach through in-depth interviews was taken with all the participants.Findings The research findings in relation to the benefits of advocacy in supporting older people going through safeguarding processes are reported. The practical limitations and factors which help and hinder advocacy support within the process are also considered. The theoretical implications for power, empowerment, and advocacy are also explored.Research limitations/implications A key limitation of this research is that it did not include older people who had been through safeguarding amongst the participants.Practical implications Key implications for practice and policy are discussed.Originality/value The paper provides an overview and critique of empowerment in adult safeguarding and the role that advocates play in promoting this key principle. [ABSTRACT FROM AUTHOR]

This paper explores practice examples relating to young people's transitions from care to adulthood. It discusses examples drawn from young people's pathways to adulthood, leaving care law and policy and participation. The paper concludes with a discussion of the research evidence on promoting the resilience of young people from care to adulthood, by proposing a framework for evaluating the impact of practice. It is suggested that practice should be interrogated in respect of the contribution made to stability and continuity, educational achievement, involving young people, preparation and support into adulthood, and health and well‐being. [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]

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

In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non‐statutory home‐care providers (for‐profit, not‐for‐profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home‐care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi‐structured telephone interviews with 20 managers of for‐profit home‐care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home‐care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time‐consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal–steward relationships in contracting. [ABSTRACT FROM AUTHOR]

This paper examines the association between workforce retention and related staffing measures and the quality of English care homes using a national database of social care providers' staffing. The analysis finds significant correlations between quality and the levels of staffing vacancies and retention of both residential and nursing homes, but no association was found between quality and the use of temporary contract workers nor the resident to staff ratio. Only for staff vacancy rates was there a significant difference in the size of these relationships between types of home. The findings suggest that quality could change for the average care home with a relatively small alteration in staffing circumstance. Long-term care is a labor-intensive industry and many countries face relatively high levels of staff turnover and job vacancy rates. These findings are therefore of interest for policy internationally and for England in particular, where the development of social care recruitment and retention strategies are ongoing. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present a framework for examining variation in care coordination arrangements for older people. Design/methodology/approach – A multi-method approach was adopted combining analysis of secondary data and primary data. There were two stages: the development of the framework and its constituent attributes and indicators; and its validation from two perspectives: a meeting with managers and focus groups with practitioners. It was informed by an existing generic framework; subsequent policy guidance; data from an English national survey; previous research; and international literature. Findings – The framework comprises 19 attributes each with indicators measuring performance relating to: organisational arrangements influencing service delivery; the performance of core tasks of care coordination; and differentiation within the process to distinguish between responses to different levels of need. Originality/value – Care coordination arrangements in England are characterised by diversity. This paper provides a framework for evaluating local arrangements thereby highlighting strengths and where improvements are needed. It offers a means to promote programme fidelity. As such it has utility for both service commissioners and providers. [ABSTRACT FROM AUTHOR]

Emotions such as guilt and blame are frequently reported by non-breastfeeding mothers, and fear and humiliation are experienced by breastfeeding mothers when feeding in a public context. In this paper, we present new insights into how shame-related affects, cognitions and actions are evident within breastfeeding and nonbreastfeeding women's narratives of their experiences.As part of an evaluation study of the implementation of the UNICEF UK Baby Friendly Initiative CommunityAward within two primary (community based) care trusts in North West England, 63 women with varied infant feeding experiences took part in either a focus group or an individual semi-structured interview to explore their experiences, opinions and perceptions of infant feeding. Using a framework analysis approach and drawing on Lazare's categories of shame, we consider how the nature of the event (infant feeding) and the vulnerability of the individual (mother) interact in the social context to create shame responses in some breastfeeding and non-breastfeeding mothers.Three key themes illustrate how shame is experienced and internalised through 'exposure of women's bodies and infant feeding methods', 'undermining and insufficient support' and 'perceptions of inadequate mothering'. The findings of this paper highlight how breastfeeding and non-breastfeeding women may experience judgement and condemnation in interactions with health professionals as well as within community contexts, leading to feelings of failure, inadequacy and isolation. There is a need for strategies and support that address personal, cultural, ideological and structural constraints of infant feeding. [ABSTRACT FROM AUTHOR]

During adolescence, risk to young people's safety shifts from familial to community contexts. Contextual safeguarding has emerged in response to this dynamic; by providing a conceptual framework through which to incorporate extra-familial contexts (and those who manage them) into traditionally family focused child protection systems. This paper uses Geographic Information System mapping techniques to explore the extent to which bus boarding data could be used to: target protective interventions in public spaces; evidence routes where young people may be vulnerable; and build local area problem profiles. In doing so it provides foundational evidence for including transport providers in contextual safeguarding systems. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis, and to address the challenge of change, exploring the necessary components beyond an action plan to ensure that findings and recommendations are embedded in policy and practice.Design/methodology/approach Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. The repetitive nature of the findings prompts questions about how to embed policy and practice change, to ensure impactful use of learning from SARs. A framework for taking forward an action plan derived from an SAR findings and recommendations is presented.Findings Familiar, even repetitive findings emerge once again from the thematic analysis. This level of analysis enables an understanding of both local geography and the national legal, policy and financial climate within which it sits. Such learning is valuable in itself, contributing to the evidence base of what good practice with adults who self-neglect looks like. However, to avoid the accusation that lessons are not learned, something more than a straightforward action plan to implement the recommendations is necessary. A framework is conceptualised for a strategic and longer-term approach to embedding policy and practice change.Research limitations/implications There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here enables conclusions to be reached about issues to address locally and nationally to transform adult safeguarding policy and practice.Practical implications Answering the question “how to create sustainable change” is a significant challenge for SARs. A framework is presented here, drawn from research on change management and learning from the review process itself. The critique of serious case reviews challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.Originality/value The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of following up SARs by using the findings and recommendations systematically within a framework designed to embed change in policy and practice. [ABSTRACT FROM AUTHOR]

Summary This paper reports on part of a research study carried out in three local authority adult social care departments in England, which explored links between adult safeguarding and personalisation. The study included statistical analysis of data on safeguarding referrals and the take up of personal budgets and qualitative interviews with managers, social workers, other staff working on safeguarding and with service users. The paper reports the findings from 16 interviews with managers and social workers, highlighting their perspectives and experiences. Findings Five main themes emerged from our analysis: contexts and risk factors; views about risks associated with Direct Payments, approaches to minimising risk; balancing risk and choice; and weaving safeguarding and personalisation practice. Social workers identified similar ranges and kinds of risks to those identified in the national evaluation of Individual Budgets. They described a tension between policy objectives and their exercise of discretion to assess and manage risks. For example, some described how they would discourage certain people from taking their personal budget as a Direct Payment or suggest they take only part of a personal budget as a Direct Payment. Application This exploratory study supports the continued need for skilled social workers to deliver outcomes related to both safeguarding and personalisation policies. Implementing these policies may entail a new form of ‘care and control’, which may require specific approaches in supervision in order to ensure good practice is fostered and positive outcomes attained. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to detail the research and findings from a piece of work commissioned by the Local Government Association in England, in May 2013 into the current implementation of integrated care Design/methodology/approach - The field research was carried out by Integrating Care, a collaborative drawn from leading academics, health and social care executives, analysts and clinicians working in the field of integrated care; along with consultancy support from public sector consultancies PPL and GE Healthcare Finnamore. It comprised a series of local interviews, workshops, modelling and analysis and ongoing engagement. Findings - The paper describes the outputs that were delivered to support the development of "whole-system" integrated health and social care drawing on national and international best-practice, and knowledge gained from experiences of implementation. Social implications - The paper concludes by drawing together the key lessons from the overarching analysis of whole-system integration. This includes the opportunities and the complexities of redesigning and re-implementing better co-ordinated health and social care provision at scale, as experienced in England currently. Originality/value - The paper describes the specific challenges posed through the fieldwork and ongoing development process of integration in England, and the paper reflects upon some of the deeper questions that this has led to. The paper then draws together the research and analysis with emerging, strategic questions around the concept of value in health provision; and begins to question whether this has yet been demonstrated; and, if not, what a demonstration and evidencing of "value" in this context might look like [ABSTRACT FROM AUTHOR]

Social workers in adult social care are at particular risk of job-related stress, although the contribution of different organisational and policy changes to this phenomenon is subject to debate. This paper explores a theoretical framework from the occupational psychology literature (the Job Demand/Control Model) to identify the characteristics of those most at risk of stress, in a sample of 249 social workers and other care managers working in English adult social services from the Individual Budget (IB) pilots. It finds that it is the particular combination of high work pressures, with a lack of control over decision making and resources needed to do the work, that are detrimental to job satisfaction. The study also finds that staff involved in delivering IBs were over twice as likely to be at risk of stress compared to those without any IB holders on their caseload. In-depth interviews with forty-eight care managers identified widespread complaints of additional pressures relating to IBs, but also the possibility that these may lessen as the policy evolves. The paper concludes that the Job Demand/Control Model is a helpful framework for evaluating the job-related impact of social work changes, particularly when part of a multi-methods approach. [ABSTRACT FROM AUTHOR]

Research suggests that intimate relationship violence and coercive control are prevalent in young people's relationships. Furthermore, young people often fail to recognise such behaviour as abuse. While such findings indicate the normalisation of controlling and coercive behaviours amongst young people, there is little focus on how these behaviours are normalised. This paper presents findings from a study exploring young people's experiences and expectations of intimate relationships. Focus groups were conducted with young people (aged 13 to 18 years) in schools in the West Midlands, England. Young people talked of navigating precarious and competitive heterosexual relationships. Their expectations and negotiations of these relationships often upheld and reinforced gender double standards around dating practices. Young people's discussion also highlighted how they came to accept and rationalise controlling and coercive behaviours as 'love', 'care' and 'protection', legitimising these practices as reasonable. Heteronormativity remains a dominant discourse shaping young people's experiences and expectations of relationships with coercion and control being defining features of this discourse. Supporting young people to critically examine constructs of heterosexuality and gender norms should be a key component of England's forthcoming statutory Relationship and Sex Education. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? Primary care and, in particular, general practice ( GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems., What this paper adds to existing knowledge? Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service ( PCLS), developed in 2011 in inner London., The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria., What are the implications for practice? This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary., Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness., Abstract Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse ( PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. [ABSTRACT FROM AUTHOR]

This paper examines the ‘coming out’ decisions at work of four lesbian, gay and bisexual (LGB) teachers in England. It argues that such decisions are complicated by heteronormative discursive practices within schools that render LGB sexualities silent while simultaneously demanding that they are spoken. This double bind for LGB teachers as well as the professional and personal implications of choosing to come out or not to come out within the workplace is examined. The paper demonstrates that three choices dominate participants' experiences of coming out at work: to speak to no one at work about the private world, to come out to colleagues and to come out to colleagues and students. The paper posits, however, that the narrative devices deployed within coming out (at work) stories are limited by linguistic techniques that constrain the telling of sexual selves to the binary categories of straight or gay/lesbian. The possibilities for teachers whose lives and experiences interrupted the dominant heteronormative discourse are also examined. [ABSTRACT FROM PUBLISHER]

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]

New relationships between service users and the welfare state have emerged as a result of governmental strategies of public service reform in which participation has appeared as the cure for a putative welfare dependency. A new public has been invoked in technologies of governance which have conflated responsible citizenship with participation in the marketplace and have aimed to change the behaviour of welfare service users accordingly. This paper investigates the ability of welfare service users to resist, or amend, the disciplinary intentions of these discourses, to constitute ‘counter-publics’, and to formulate their own visions of public services. Drawing on research with English social housing tenants engaged in participation with their quasi-public landlords, and applying a theoretical framework based on the work of feminist and queer theorist Judith Butler, the paper explores the behavioural effects of participation on tenants and evidences their use of consumerist and communitarian discourses to construct alternative perceptions of a ‘public’, and re-imagine their relationship with public services. [ABSTRACT FROM PUBLISHER]

A central element in the privatization of council housing has been the development of stock transfer policy. A variety of perspectives on this process have been explored including the impact on accountability relations; however, the tenants’ experience is almost completely absent from this literature. The paper develops a case study that draws on the experience of the tenants involved in a stock transfer. In the process stock transfers, and related accountability relations, are shown to be contested with tenant-led campaigns challenging this neoliberal inspired policy. The case study illustrates the power and financial resource asymmetries in transfer campaigns with a range of anti-democratic tactics employed by those pursuing the transfer. On the basis of a critique of neoliberalism, the stock transfer process is seen as an attack on the previous democratic control of council housing, which is replaced with ‘governance by experts and elites’ and private sector inspired corporate governance forms of accountability. Thus the paper seeks to answer two questions; how democratic is the transfer process and what are the long-term implications for democratic accountability in the social housing sector. [ABSTRACT FROM PUBLISHER]

This paper aims to fill an important gap in cross-national comparison conducted by a solo-researcher through an example of a three-nation study of the long-term care of older people, in order to make transparent some of the key issues—time and space, comparability, culture and language—involved in the practical implementation of cross-national qualitative research. It is argued that cross-national comparison is very demanding in terms of language skills, cultural understanding, resources and time to provide a rigorous comparative instrument and outcome. Key approaches that address challenges for solo-researchers are: careful attention to geographical location and flexibility in timetable and programmes for gathering data; employment of multi-disciplinary knowledge to address the complexity of the research topic; application of a multi-method and multi-layer approach in data collection and analysis; recognition of the caring culture; and sensitivity of national as well as local language. In contrast to the challenges, the paper concludes with an analysis of the added value of solo-researcher activity in cross-national research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales. Design/methodology/approach: Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings: All organisations had a specific policy referring to either "observation and engagement" or "observation". The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement. Research limitations/implications: This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice. Practical implications: Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with. Originality/value: To the best of the author's knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide new insights into the contribution and experiences of non-statutory sector (voluntary) services delivering care coordination.Design/methodology/approach This qualitative study, based on face-to-face semi-structured interviews with 17 managers from a range of non-statutory sector services, used thematic data analysis supported by a framework approach.Findings Four themes emerged: commissioning arrangements undermined non-statutory sector development; working relationships between statutory and non-statutory services required time and energy to navigate and sustain; the establishment of a niche role in the larger network of provision; and tensions relating to future developments. The non-statutory sector was found to provide a mix of services, including specialist provision targeting specific communities that complemented or substituted for those provided by the state. Managers wanted their services to be recognised by the statutory sector as equal partners in the delivery of care coordination and were also keen to retain their independence.Practical implications Findings provide information for service commissioners and managers from statutory and non-statutory sectors indicating a complex set of experiences and views regarding the role of the latter. This is particularly salient in a political landscape which has increasing expectations of their involvement in the provision of care coordination.Originality/value This study considers the work of the non-statutory sector in the delivery of care coordination to adults and older people, an area under-reported to date. It suggests that there are opportunities available for these services to become embedded within a wider social care system and to excel by retaining or developing specialist roles and services. [ABSTRACT FROM AUTHOR]