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The relationship between attendance at birth and maternal mortality rates: an exploration of United Nations’ data sets including the ratios of physicians and nurses to population, GNP per capita and female literacy Background. This is the third and final paper drawing on data taken from United Nations (UN) data sets. The first paper examined the global distribution of health professionals (as measured by ratios of physicians and nurses to population), and its relationship to gross national product per capita (GNP) (). The second paper explored the relationships between the global distribution of physicians and nurses, GNP, female literacy and the health outcome indicators of infant and under five mortality rates (IMR and u5MR) (). In the present paper, the global distribution of health professionals is explored in relation to maternal mortality rates (MMRs). The proportion of births attended by medical and nonmedical staff defined as ‘attendance at birth by trained personnel’ (physicians, nurses, midwives or primary health care workers trained in midwifery skills), is included as an additional independent variable in the regression analyses, together with the ratio of physicians and nurses to population, female literacy and GNP. Aim. To extend our earlier analyses by considering the relationships between the global distribution of health professionals (ratios of physicians and nurses to population, and the proportion of births attended by trained health personnel), GNP, female literacy and MMR.

Abstract The rise in chronic illness and comorbidity in Western society has resulted in an increasing emphasis on self-care initiatives. In the United Kingdom this is exemplified by the Expert Patient policy. This paper discusses the Expert Patient initiative as an example of the State’s third way approach to public health. The extent to which this policy challenges conventional power relationships between professional and patient, and fosters equal partnership is examined. In particular, how expert is defined and whether a professional understanding of the term is reconcilable with a patient’s expertise is debated. The paper argues that the Expert Patient initiative is unlikely to reconstruct chronic illness and may further complicate the State’s responsibility in meeting the needs of those with chronic illness. Issues of power within self-care are explored to illuminate the policy, and this paper argues that the Expert Patient initiative is an example of Foucault’s notion of pastoral power. Although the Expert Patient policy focuses on the rights and responsibilities of those with chronic illness, this paper concludes that there is no corresponding strategy to challenge professionals’ assumptions toward those with chronic illness. [ABSTRACT FROM AUTHOR]

Mental health services in England, in common with many other European countries, have been the subject of sustained government attention during the 1990s. Since the election of the Labour administration in Britain in May 1997, mental health services have been discussed in most Department of Health documents on health and social care policy, and mental health services in England have a new national strategy. At the same time, the local provision of mental health services within NHS Trusts has been undergoing organisational change. This paper sets out the policy context and evidence base for the reorganisation of provider arrangements for mental health services. In addition, the results of a documentary analysis of unpublished reviews of provider arrangements in 10 localities are presented. The review identified three major themes: firstly, the reconfiguration of NHS Trusts is based around Specialist Mental Health Trusts and Community and Mental Health Trusts; secondly, the joint provision of services and/or the integration of services between health and social services is starting to appear and; thirdly, the delegation of responsibility to localities based on Primary Care Group/Social Services boundaries is being discussed. The paper discerns a number of trends and points to the need for further research, in particular into the relationship between organisational arrangements and effective service delivery. [ABSTRACT FROM AUTHOR]

Background Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix). Methods A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included. Results The current evidence includes high-income countries (USA, n  = 7; UK, New Zealand and Oman, n  = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n  = 4), state (n  = 1), county (n  = 1), school district (n  = 1) and city (n  = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors. Conclusion Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour. [ABSTRACT FROM AUTHOR]

In this pa per, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction. [ABSTRACT FROM AUTHOR]

Increasing numbers of adults in the UK are living with acquired brain injury (ABI), with those affected requiring immediate medical care and longer-term rehabilitative and social care. Despite their social needs, limited attention has been paid to people with ABI within the social work literature and their needs are also often overlooked in policy and guidance. As a means of highlighting the challenge that ABI presents to statutory social work, this paper will start by outlining the common characteristics of ABI and consider the (limited) relevant policy guidance. The particular difficulties of reconciling the needs of people with ABI with the prevailing orthodoxies of personalisation will then be explored, with a particular focus on the mismatch between systems which rest on presumptions autonomy and the circumstances of individuals with ABI--typified by executive dysfunction and lack of insight into their own condition. Composite case studies, drawn from the first author's experiences as a case manager for individuals with ABI, will be used to illustrate the arguments being made. The paper will conclude by considering the knowledge and skills which social workers need in order to better support people with ABI. [ABSTRACT FROM AUTHOR]

This paper reviews the lessons for evidence-based policy and practice(EBP) arising from the work of the Social Care Institute for Excellence(SCIE), a government-funded agency established in 2001 to improve social care in the UK. The paper describes a ten-year programme developing an inclusive approach to what counts as knowledge, and the challenges in ensuring that knowledge is relevant to improving practice in social work and social care. These challenges include reviewing what counts as evidence in EBP, changing the relationship between EBP and practice, and recognising the scientific value (as well as the moral imperative) of including the knowledge held by people who use services In methodological terms, the work includes developing systematic qualitative synthesis to take account of a broader range of evidence and economic evaluation appropriate to social care. The paper concludes with a discussion of some implications for international debates about the role of evidence-based policy and practice. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to draw attention to commissioning and service structures enabling implementation of evidence-based cost-effective care as illustrated by the “1419” young people’s service treating mild to moderate severity mental health difficulties in teenagers old 14 to 19 years. The authors describe relevant local contextual factors: “relational commissioning”, demand capacity planning and a receptive and safe clinical context. Design/methodology/approach – The authors used a participant observer qualitative research design to describe commissioning and service design. Treatment outcomes were analysed using a quantitative design and found significant improvement in service user mental health and daily function. These results will be reported elsewhere. Findings – The dynamics and structures described here enabled clear shared goals between service user, service purchaser, service provider and service partners. The goals and design of the service were not static and were subject to ongoing development using routine outcome measures and conversations between referrers, commissioners, service users and within the team about what was and was not working. Research limitations/implications – The methods are limited by the lack of a prospective systematic evaluation of the implementation process and by the time limitations of the service. Practical implications – Implementation of whole system change such as that envisioned by Children and Young People’s Improving Access to Psychological Therapies requires consideration of local context and process of implementation. The authors suggest key factors: consideration of “relational commissioning” with purchasers, providers and service users designing services together; case-level collaboration between services and partner agencies; smaller child and adolescent mental health teams eliminating competing task demands, permitting speed of action, providing psychological safety for staff, promoting shared goals and innovation; rigorous demand/capacity planning to inform funding. Social implications – The failings of child and adolescent mental health services (CAMHS) are detailed in the Department of Health report “Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing” (2015). The aims of the report are contingent on the ability of local health providers to implement its recommendations. The authors provide a theoretical approach to enable this implementation. Originality/value – To date there are no published papers addressing the key characteristics enabling implementation of evidence-based practice within CAMHS. The unique experience in forming the“1419” service has important implications nationally and brings together evidence of an effective service within a theoretical underpinned context. [ABSTRACT FROM AUTHOR]

Aim: To learn from two jurisdictions with mature genomics‐informed nursing policy infrastructure—the United States (US) and the United Kingdom (UK)—to inform policy development for genomics‐informed oncology nursing practice and education in Canada. Design: Comparative document and policy analysis drawing on the 3i + E framework. Methods: We drew on the principles of a rapid review and identified academic literature, grey literature and nursing policy documents through a systematic search of two databases, a website search of national genomics nursing and oncology nursing organizations in the US and UK, and recommendations from subject matter experts on an international advisory committee. A total of 94 documents informed our analysis. Results: We found several types of policy documents guiding genomics‐informed nursing practice and education in the US and UK. These included position statements, policy advocacy briefs, competencies, scope and standards of practice and education and curriculum frameworks. Examples of drivers that influenced policy development included nurses' values in aligning with evidence and meeting public expectations, strong nurse leaders, policy networks and shifting healthcare and policy landscapes. Conclusion: Our analysis of nursing policy infrastructure in the US and UK provides a framework to guide policy recommendations to accelerate the integration of genomics into Canadian oncology nursing practice and education. Implications for the profession: Findings can assist Canadian oncology nurses in developing nursing policy infrastructure that supports full participation in safe and equitable genomics‐informed oncology nursing practice and education within an interprofessional context. Impact: This study informs Canadian policy development for genomics‐informed oncology nursing education and practice. The experiences of other countries demonstrate that change is incremental, and investment from strong advocates and collaborators can accelerate the integration of genomics into nursing. Though this research focuses on oncology nursing, it may also inform other nursing practice contexts influenced by genomics. [ABSTRACT FROM AUTHOR]

Studies have suggested that universal basic income (UBI) has the capacity to have substantial health benefits across the population at national level. Multiple impact pathways have recently been theorized and there are calls for trials to explore these pathways empirically. However, very limited research has taken place at local levels to explore potential context-specific effects, or how these effects could play out in economic, social, and behavioral changes. In order to examine these effects and to think through potential issues and unintended consequences, we brought together citizen engagement groups in Jarrow, South Tyneside, in the northeast of England to explore local people's expectations and positions on the development of UBI policies and pilots prior to their implementation. We found that people's expectations regarding the potential beneficial health impacts of UBI on their communities mapped strongly onto academically theorized impact pathways. They also extended understanding of these pathways in meaningful ways. Our findings add to the literature about UBI and health and provide important insights for the future development of empirical, health focused, UBI research. [ABSTRACT FROM AUTHOR]

During the latter part of the 1980s registered nurse education was transferred from hospital-based training to higher education in Australia and the UK. Examining this transfer process, analytical attention is focused on the contrast in subsequent funding arrangements for registered nurse education between the two nations. It is argued that the difference in funding arrangements can be explained by an analysis of two separate movements impacting on health care policy in both Australia and the UK: those of professionalisation in nursing and economic rationalisation. This paper discusses the implications of these movements and the subsequent differing educational funding arrangements in terms of the professionalisation of nursing in Australia and the UK. [ABSTRACT FROM AUTHOR]

The goal of this research is to compare the healthcare information technology (HIT)-related policies and infrastructures of two very differently-run countries: The United States (US) that owns the largest private healthcare system in the world, and the United Kingdom (UK) that has the largest public healthcare system worldwide. The paper specifically focuses on the differences between the two countries' adoption of electronic healthcare record (EHR) systems, and their efforts toward interoperability, healthcare information security and privacy, and patient safety. Both authors on the paper are professionals in the HIT field and have firsthand experience designing and implementing electronic health record (EHR) systems. As a result, they both have a real-world grasp of HIT economics and the pressure of regulatory compliance. To complement their combined expertise and insight, the authors thoroughly reviewed the peer-reviewed and grey literature on healthcare policy. The paper's findings suggest that although EHR implementation and adoption are on the rise in the US and the UK alike, both countries are facing considerable hurdles in executing their vision of establishing their respective nationwide EHR systems. To improve patient health and ensure patient safety, interoperability standards that enable seamless communication amongst differing healthcare systems and proper security and privacy regulations for data collection, data handling, and data sharing are paramount., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Quality-Adjusted Life-Years (QALYs) are central to healthcare decision-making in Britain and abroad, yet their history is poorly understood. In this paper, we argue that a more in-depth and political history of the QALY is needed to allow a critical evaluation of its current dominance. Exploiting rich data from archives and 44 semi-structured interviews conducted between 2015 and 2018, we employ Multiple Streams Analysis to construct a complex and dynamic picture of how the idea of QALYs emerged and was adopted within UK health policy. Through its historical and political approach, the paper illuminates the relative roles in the policy-making process of experts (especially economists) and politicians as 'entrepreneurs' in the development of new ideas; how these were influenced by negotiation within established and emerging institutional structures; and the role of serendipity and crisis., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This paper concerns two practices, public consultation and user involvement, whose adoption has been urged upon the UK National Health Service in recent years. Public consultation is a local attempt to seek the views of a broad constituency of persons. User involvement is a local attempt to include organized groups of service users in the planning, and occasionally the management, of such services. The paper has four objectives. First, it locates the topic in the context of several related current debates. Second, it outlines the main findings of a recent empirical study of public consultation as they relate to the above debates. Third, it summarizes the relevant findings of an empirical study of user involvement. Finally, it examines these two practices as "technologies of legitimation" which can be seen as a means by which managerial legitimacy is maintained in the context of an increasingly pluralistic policy arena. [ABSTRACT FROM AUTHOR]

Although community care has been the professed policy of successive governments over three decades, according to the Prime Minister's own adviser, Sir Roy Griffiths, `in few areas can the gap between political rhetoric and policy on the one hand or between policy and reality in the field on the other hand have been so great'. This paper examines the extent and causes of this `implementation gap' in respect of services for people with mental handicaps-a consistent priority group for national policymakers. We examine centre-periphery relations in the health and personal social services in the light of Rhodes' power-dependence framework and his concepts of policy networks and policy communities. The NHS has been described as the archetypal professionalised policy network but we conclude that it is possible to account for implementation failures in community care only partly in terms of the dominance of the medical professions' values and interests and the deficiencies of accountability and control due to clinical autonomy. Such failures are due also to the inherently limited power of the centre. Sub-central units are not merely its meek agents. Moreover, the centre must explicitly structure local environments by itself providing a coherent framework of service and resource policies compatible with the national objectives it is seeking to achieve. [ABSTRACT FROM AUTHOR]

This paper evaluates the possible relationships between Northern NGOs and Southern governments in light of the growing involvement of NGOs in social services in Africa. It draws on the specific case of Oxfam-UK's support to health care in Uganda, Malawi and Zambia. I propose a model for understanding NGO policy concerning the NGO–state relationship. I emphasize the importance of context in shaping NGO policy and the influence of other actors, particularly donors and Southern NGOs, on the Northern NGO–Southern government interface. In particular, the paper examines the possible consequences of NGO programming that is considered to be ‘gap-filling’, for the actual services provided, for the NGO, and for the host government. I will consider the strategic choices available as an NGO attempts to address these consequences. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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Street‐level bureaucracy is an increasingly useful way to understand how strategic policy is implemented in day‐to‐day practice. This approach has uncovered the ways that individual health and social care practitioners work within institutional constraints to influence policy implementation at the micro‐level. Nonetheless, despite the diversity of settings where these street‐level bureaucrats (SLBs) work, little attention has been focused on the impact of place on policy delivery. This paper draws on empirical research to examine the ways that delivering government domestic abuse policy in the intimate space of the family home shapes the delivery of strategic policy in the everyday. Drawing on qualitative research with Health Visitors (HVs) in the UK in 2016, the study findings illuminate the ways that the material, socio‐spatial and idealised boundaries of the family home shape the implementation of policy. Key themes in the HV's narratives emerged as they described themselves as both a danger and in danger in the family home. In challenging the ontological security of the home (Giddens 1990) – privacy, security and control are key concepts here – HVs described how they shape their actions to achieve policy outcomes while simultaneously managing threats to the home, to professional identity and to self. [ABSTRACT FROM AUTHOR]

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

Efficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an 'age of austerity' purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare service. This paper draws from a qualitative study conducted in three A&E Departments in England to explore the effects of austerity policies on the everyday experiences of doctors and nurses working in Emergency Departments. It discusses the operationalisation of efficiency in A&E, in a climate of austerity, and its effects on the experiences and practices of healthcare professionals. It uses the empirical data as a springboard to highlight the role of structures and regulations, in this case targets and protocols, in how core healthcare ethical values, such as empathy, are exercised in practice. It provides an analysis of the normative role structures and regulations can play on the perception and practice of professional duties and obligations in healthcare. [ABSTRACT FROM AUTHOR]

The growing use of psychoactive substances in everyday life, the increasing experimentation among users and the potential of poly drug use for non-medical, lifestyle or enhancement purposes presents an evolving policy challenge. The paper aims to build on previous research to gain a more in-depth qualitative understanding of the imaginaries around pharmaceutical cognitive enhancement (PCE). It focuses in particular on how the so-called pharmaceutical cognitive enhancing drugs (PCEDs) might be used and the social acceptability of these uses across multiple social contexts and groups. Data come from 23 focus groups (99 participants), representing a wide range of social groups, recruited in the UK. We discuss four distinct 'enhancement practices' where PCE use was conceptualised as a way to (1) become the best version of oneself; (2) gain a competitive edge over others; (3) for personal achievement or well-being; and (4) promote personal/public safety. The findings problematise the term 'enhancement' by showing the different ways in which the use of pharmaceutical 'enhancement' drugs can be imagined and understood. We argue for the value of policy responses that acknowledge and respond to a wider range of enhancement practices including those of prospective user groups. [ABSTRACT FROM AUTHOR]

This paper addresses policy change in Britain since 2010 across the three fields of domestic welfare, migration and asylum, and analyses the association between welfare, conditionality and control through the lens of civic stratification. Drawing on the work of Richard Munch and Mary Douglas, it moves beyond existing literature in this area to show that the more complex the classification in play, and the more severe its boundary implications, the more likely the emergence of contestable margins. Informed by Munch's 'battlefield' approach, it provides a discussion of contestable margins in each of the three policy fields and outlines the nature and source of challenges that emerge within the 'institutional battlefield'. A concluding section reflects on what is revealed by viewing welfare, migration and asylum within the same conceptual frame, identifying an emergent welfare paradigm that displays recurrent problems across all three fields. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the changing meaning of personalisation from the New Labour era of bespoke, integrated family support to the more recent implementation of personal budgets for disabled children to deliver “choice and control”. The paper explores the discursive change from early help to “intervention”, the shifting conceptualisation of parents and the turn away from family support towards a focus upon individualised commissioning to meet needs. Design/methodology/approach – In addition to a literature review of policy shifts, findings presented are taken from an ethnographic case study of one team of children’s disability social workers. Observations were undertaken of the team in the office space and at meetings, in addition interviews were conducted with all team members and with seven families. An interpretivist and qualitative approach was adopted throughout. Findings – Findings reveal the frontline and familial challenges of delivering choice and control in a climate of austerity and child-centricism. Salient points for integration around families and between organisations as personalisation narrows in scope are also considered. Research limitations/implications – Findings are taken from one case study site; further research in different sites is required to consider the array of understandings and experiences across the social care landscape and to provide a strong empirical baseline. Originality/value – The paper reports on one of the first ethnographic studies of personalisation in children’s services. The paper is of value to practitioners and managers in social care and the NHS. It is also of value to academics exploring the conceptual and practical issues of individualised care. [ABSTRACT FROM AUTHOR]

This conceptual paper is written from the perspective of two qualified and registered social workers who are former supervisors/managers in both statutory and voluntary children’s services. Now as social work academics, the authors of this paper consider the British Association of Social Workers (BASW) supervision policy in the context of current debates about social work and supervision in child protection practice. Whilst optimistic about the intensions of BASW, we explore the social and political landscape in which the BASW policy has been developed and give consideration to the tensions faced by a profession seeking to reclaim a defining feature of professional social work. Using Kadushin’s model of supervision where the functions of supervision are outlined as three primary domains: educational, administrative and supportive, this paper will examine the interconnectedness of these elements and their relevance in the debates and policies that have focussed on the event that is supervision in social work in the UK. This paper will also introduce a critical challenge that seeks to refocus attention to the nature of the relationships involved in carrying out the task of supervision in the environment in which child protection social work is practised. [ABSTRACT FROM PUBLISHER]

Griffith Edwards played an important role in cannabis policy debates within government advisory committees in the United Kingdom from the early 1970s until the early 1980s. This has largely been hidden from public knowledge by the confidentiality of these committee discussions. The purpose of this paper is to use Griffith's writings and the results of recent historical scholarship to outline the views he expressed, the reasons he gave for them, and to provide a brief assessment of his contribution to the development of British cannabis policy. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe how NHS Sutton Clinical Commissioning Group (Sutton CCG) is working with nursing homes, residential homes and other health and social care organisations in Sutton to improve the quality of provision for residents in nursing and residential homes “care homes”. Design/methodology/approach – The paper explains how Sutton CCG engaged with care homes initially to seek their views on whether they wanted support and what support they would value. It describes what arrangements Sutton CCG put in place for managers and staff in local care homes to provide support face-to-face. The paper outlines the key areas for improvement that Sutton CCG and the care homes are focusing on. It includes examples of work carried out jointly by the care homes and Sutton CCG to improve the quality of care for residents. It goes on to describe joint-working arrangements between the CCG, London Borough of Sutton and other health and social care organisations to ensure the overall quality of care homes in Sutton. Findings – The paper outlines feedback from care home managers and staff who were invited to share their views about what support they wanted from Sutton CCG. It includes early feedback from care homes about the support put in place and the areas where they have found it most useful. Practical implications – In the UK many older people live in care homes. Britain has an ageing population so the need for residential and nursing homes and the numbers of people living in care homes is only likely to increase. Our ageing population also places additional demands on the NHS, with residents in care homes often spending time in A&E and lengthy spells in hospital. This paper highlights how CCGs and other health and social care organisations can work with care homes to improve the health and wellbeing of older residents in care homes and reduce pressures on other health services. Originality/value – Sutton CCG has put in place new arrangements for working with care homes that aim to support carers to improve the lives of their older residents. The paper shares practical examples of support that the CCG has provided which has successfully improved care and decision making in care homes; early indications show this has reduced 999 calls and conveyances to hospital. Sutton CCG, London Borough of Sutton and other statutory organisations with responsibility for care homes in Sutton have also set up a joint intelligence group to gain an overall picture of the quality of the borough’s care homes. [ABSTRACT FROM AUTHOR]

Accessible summary People with learning disabilities find it difficult to get their health checked and to get information about their health., Community learning disability nurses play an important role in supporting people with learning disabilities to stay healthy., Community learning disability nurses support people with learning disabilities to get their health checked and to get information about their health., Summary International studies have shown poor uptake of public health initiatives by people with learning disabilities. In addition, studies have shown that people with learning disabilities experience poor access to public health services. The contribution of community learning disability nurses in meeting the public health needs of people with learning disabilities has evolved differently across the UK resulting in conflicting understanding of this role. This paper reports on a study that explored and explained the contribution of community learning disability nurses in the implementation of public health policies for people with learning disabilities. The study demonstrates that community learning disability nurses are involved in health surveillance, health promotion, health facilitation, health prevention and protection, health education, and healthcare delivery. [ABSTRACT FROM AUTHOR]

This paper explores the shifting landscape of civil society alongside the emergence of ‘Big Society’ in the UK. We do so as we begin a research projectBig Society? Disabled people with learning disabilities and Civil Society[Economic and Social Research Council (ES/K004883/1)]; we consider what ‘Big Society’ might mean for the lives of disabled people labelled with learning disabilities (LDs). In the paper, we explore the ways in which the disabled body/mind might be thought of as a locus of contradictions as it makes problematic Big Society notions of: active citizenship and social capital. Our aim is to queer(y), or to trouble, these Big Society ideas, and to suggest that disability offers new ways of thinking through civil society. This leads us to three new theoretical takes upon civil society: (1) queer(y)ing active citizenship, (2) queer(y)ing social capital and (3) shaping, resisting and queer(y)ing Big Society. We conclude by suggesting that now is the time for disabled people with LDs to re-enter the fray in a new epoch of crip civil society. [ABSTRACT FROM PUBLISHER]

Purpose - The issues of concern to older people and likely to shape their voting behaviour need to be understood and appreciated. The paper aims to discuss these issues. Design/methodology/approach - This policy-oriented review draws on recent research, including surveys, focus groups and ethnographic interviews to identify such issues in the UK older population. Findings - Older people are more likely to vote and to prioritise policy issues relating to immigration, the NHS and the economy - but the outcome of their vote is more likely to be determined by affinity with a party's broader ideological position than with the specific policies contained in their manifesto?. Practical implications - Older people appear more likely to support Conservative party values and priorities, but their potential growing support for UKIP may be underestimated as several major surveys do not prompt for this party. The less certain standing of both Conservative and Labour may therefore be further undermined by unappreciated shifts in the "grey vote". Originality/value - This commentary highlights the increasing importance of the "grey vote" at a time of increasing unpredictability in support for mainstream parties. [ABSTRACT FROM AUTHOR]

There has been a succession of policy documents related to active travel published by the British government since the implementation of a National Cycle Network (NCN) in 1995. However, as the latest National Travel Survey (NTS) reveals, the number of journeys made by bike in the UK has remained steadfastly around only 2% (Department for Transport [DfT], 2018a). By using documentary analysis of the available official policy documents and statements, the aim of this paper is to make sense of the policies that have been published concerning active travel (AT) in England. This is done from a figurational sociological perspective. Three key themes emerge from the analysis: (1) the rhetorical, advisory level of the vast majority of the policies; (2) the reliance on a wide network of local authorities to implement AT policy; and (3) the focus placed on individuals to change their behaviour. Furthermore, the analysis reveals that despite a large number of policy publications from a range of government departments claiming to promote AT, little has actually changed in this time period in terms of a national agenda. Despite the successive policies, it seems there is little appetite on behalf of recent governments to make widespread infrastructural changes, where instead the focus has largely been on persuading the individual to seek more active modes of travel, increasingly for their own, individual 'health' gains. Highlights •The paper is based on documentary analysis of available official policy documents from UK government on active travel since 1996 • The findings reveal the largely rhetorical, advisory level of the vast majority of the policies, which contributes to a lack of overall success in promoting active travel • The lack of success is compounded further by a reliance on a wide network of local authorities to implement active travel policy, when most local authorities appear more concerned with transport issues related to motorised vehicles • The findings reveal that active travel policy has becoming increasingly focussed on health gains that might be made from increasing the number of trips made by bicycle • The overwhelming focus of the policy documents analysed, however, is on encouraging individuals to change their behaviour, a process regarded as 'healthism', and one most sociologists of health suggest is likely to fail as a result • We conclude by suggesting that if the government is serious about wanting to see a 'step change' in the way in which people travel, particularly over shorter distances, then there is a need to have a more forceful approach to implementing policy within local authorities at the same time as making more substantial infrastructure changes to encourage cycling [ABSTRACT FROM AUTHOR]

National policy initiatives are faced with challenges in their partnership development and sustainability. The National Dementia Strategy for England recommended Dementia Adviser (DA) and Peer Support Network (PSN) services and 40 demonstration sites were established. In this paper, we report on the national evaluation of these demonstration sites, with specific reference to aspects of organisational development. The research used a mixed-methods design with three main strands: (i) activity and outcome monitoring; (ii) organisational surveys and collaborative discussion; (iii) in-depth case studies in eight of the 40 sites. This paper focuses primarily on three rounds of organisational surveys distributed to all 40 demonstration sites over a period of 21 months and interviews in the case studies. Data identify the significance of infrastructure within immediate services as well as the position of services within the external infrastructure of the wider health and social care landscape. Partnership - both internally and externally - was key to establishing and sustaining services that flourished. When working well, DAs and PSNs acted as a link between services and people with dementia at the same time as filling gaps in existing support, providing information, advice and interpersonal support that was tailored to individual needs and circumstances. In conclusion, to achieve the full potential and sustainability of services requires them to be in an organisational space that allows them to work in partnership and collaboration with other services, and that values their distinct knowledge of their communities. [ABSTRACT FROM AUTHOR]

Research Highlights and Abstract The article investigates which of two competing accounts of contemporary British policy making better captures the nature of policy making during episodes of major reform of the English NHS., The analysis of the formulation of the English NHS Plan 2000 suggests that the Asymmetric Power Model better describes the reality of NHS policy making under New Labour than the Differentiated Polity Model., Although the process of developing the Plan showed signs of a more open policy process, it was tightly controlled and personally led by the Secretary of State for Health and his close advisers, reflecting an underlying British political tradition that emphasises the idea that the NHS has to be continuously improved with change led from above by central government., However, when compared to the processes underpinning Thatcher's Ministerial Review of the NHS and the 2010 Coalition government's White Paper, if ever NHS policy making in England were to have come close to the Differentiated Polity Model, it would have been during the formulation of the 2000 NHS Plan., Through a case study of the formulation of the English NHS Plan 2000, this article investigates which of two competing models of the British policy process-the Differentiated Polity and Asymmetric Power Models-better describes the reality of major NHS reform policy making under New Labour. The process of developing the Plan showed signs of a more open policy process, seemingly closer to the DPM. There was contestability of policy advice and limited involvement of the medical profession through its representative bodies. However, the process was tightly controlled and personally led by the Secretary of State and his advisers, with the direct involvement of the Prime Minister throughout. Two key moments of interest group involvement-the Modernisation Action Teams and the signing of the Plan by health sector organisations-were marked by power asymmetries. Overall, the APM better describes the reality of major reform policy making under New Labour. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to appraise local absent without leave/missing persons policy in use across the nine NHS mental health trusts providing services across the Greater London region. Design/methodology/approach -- A review of the literature on best practice management was conducted, evidence collated and an appraisal tool produced. This tool was used to systematically appraise individual policies. Findings -- Despite some core consistency in policy, there was some notable variability in guidance. Novel and unique approaches to management were also identified. Research limitations/implications -- It is recognised that policies often arise from pragmatic approaches using local multi-agency agreements and therefore some variability across London was expected. It is also recognised that the audit tool produced is unvalidated but does reflect the best available evidence. Practical implications -- The authors have shown policy variability in the management of what is a common psychiatric problem across a relatively homogenous population. Standardisation of policy is likely to improve the efficiency in managing these incidents as well as encourage sharing of innovative practice. The authors also illustrate practical implications for local policy benchmarking in the absence of clearly defined national standards. Originality/value -- This study has shown the variability of policy in managing a common problem faced on psychiatric wards. It also highlights issues related to policy development on a local and regional level. [ABSTRACT FROM AUTHOR]

Objective The study aims to review the literature about strategies that can enhance the public health role of community pharmacists in the UK; and to identify main themes emerging from the literature as well as identify gaps there from. Methods Relevant literature from both the UK and overseas was identified, through electronic database searches. The search was limited to the period from January 2007 to May 2012. Key findings There are numerous opportunities for community pharmacists in public health. Following the review of knowledge and information, a wide range of strategies that could help enhance the public health role of community pharmacists in the UK were identified. The dominant themes included strategies to enhance the public health role of community pharmacists through: enhancing the effectiveness of communication techniques of students and pharmacists; advancing pharmacy practice experience of students in public health; enhancing the public health content of pharmacy curricula; managing legitimate medication needs of the public to identify/prevent drug-related problems; as well as promoting patients' self-management capacities. Conclusions Although a wide range of strategies that could help enhance the public health role of community pharmacists in the UK were identified, there were, however, gaps in the UK evidence base. There is a need to enhance, among other things, the public health training and skills of pharmacists, enabling the development of a mixed market in community pharmacy practice by contracting public health services directly to individual pharmacists, as well as pharmacists using newer technologies, including the social media, to enhance public health practice. [ABSTRACT FROM AUTHOR]

Introduction: Collaboration was legislated in the delivery of integrated care in the early 2000s in the UK. This research explored how the reality of practice met the rhetoric of collaboration. Theory: The paper is situated against a theoretical framework of structure, agency, identity and empowerment. Collectively and contextually these concepts inform the proposed model of 'collaborative agency' to sustain integrated care. The paper brings sociological theory on structure and agency to the dilemma of collaboration. Methods: Participative action research was carried out in collaborative teams that aspired to achieve integrated care for children, young people and families between 2009 and 2013. It was a part time, PhD study in collaborative practice. Results: The research established that people needed to be able to be jointly aware of their context, to make joint decisions, and jointly act in order to deliver integrated services, and proposes a model of collaborative agency derived from practitioner's experiences and integrated action research and literature on agency. The model reflects the effects of a range of structures in shaping professional identity, empowerment, and agency in a dynamic. The author proposes that the collaborative agency model will support integrated care, although this is, as yet, an untested hypothesis. [ABSTRACT FROM AUTHOR]

There is no statutory registration as a sonographer available in the United Kingdom (UK) and the titles of ‘sonographer’ and ‘ultrasonographer’ are not legally protected. The majority of sonographers are statutorily registered with the Health and Care Professions Council or Nursing and Midwifery Council as they have a professional background as a radiographer, clinical scientist, nurse, physiotherapist or midwife that allows this, but this registration is not as a sonographer. For otherwise well-qualified and experienced sonographers, statutory registration is impossible to achieve at the present time and they have no statutory regulatory home. This can lead to problems for the sonographers themselves, for the patients and public in terms of protection and for employers when selecting staff. This paper discusses the complex registration situation for sonographers in the UK and includes reference to the alternative voluntary registers and their possible accreditation by the Professional Standards Authority. [ABSTRACT FROM PUBLISHER]

Purpose – The purpose of this paper is to report on a personalisation project run by the Challenging Behaviour Foundation (CBF) which aims to share the identified barriers and solutions to personalisation for people with severe learning disabilities and behaviour described as challenging. Design/methodology/approach – A small project team consisting of a project manager, housing specialist and positive behavioural support specialist worked as consultants with selected East Midlands local authority and NHS commissioners and with six families from other areas. Findings – The main barrier to personalisation was the volume of, and priority given to, safeguarding referrals by frontline commissioning social care workers. This reduced capacity for a proactive approach to support planning. Workers who participated in the project appreciated the expertise and support of the project team and the opportunity to reflect on their work. However, a major project limitation was a lack of time for commissioning workers and managers to engage with the project. Practical implications – The project report provided a series of recommendations for action for commissioners of health and social care support and for families. The Winterbourne View scandal broke as the project was established and its findings are helpful to anyone taking forward action plans to improve commissioning practices to avoid the continued commissioning of poor quality care. Originality/value – The project sought direct engagement in planning in "real time" with frontline commissioning staff and the families of people with severe learning disabilities and behaviour described as challenging. It is hoped that the value of the paper will be to influence NHS and LA commissioners to improve their response to people with severe learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the impact of young people's participation in organised sport on their educational outcomes. Design/methodology/approach – Systematic review of the literature. A comprehensive search was used to identify all research evidence about engagement, impact and value in culture and sport. A combination of manual and automated screening was used to select studies for inclusion in this review based on pre-specified criteria. Included studies had to use a "high"-quality experimental research design, focus on children and young people and have quantitative educational outcome measures. Results from the individual studies were transformed into a standardised effect size and meta-analysis was used to combine the results from individual studies where appropriate. Findings – Young people's participation in sport may lead to improved educational outcomes. Young people's participation in organised sports activities, when compared to non-participation, improves their numeracy skills. Young people's participation in organised sport linked with extra-curricular activities, when compared to non-participation, improves a range of learning outcomes for underachieving pupils. These findings are based on six "high"-quality studies conducted in the UK and North America. Study populations included young people within the range of four to 16 years old. Originality/value – This paper builds on the existing evidence base in two main ways. First, it focuses specifically on the impacts associated with organised sport whereas previous reviews have had a broader focus. Second, it uses meta-analytic methods to synthesise study findings. This paper provides pooled effect sizes for overall educational impacts and translates these into potential changes in test/grade scores. [ABSTRACT FROM AUTHOR]

Persistent health inequalities pose a continued research and policy challenge in the United Kingdom and elsewhere. Current approaches to health research and promotion are predicated on a distinction between wider, social structural causes and individual, health‐related behaviours often conceived of as lifestyle choices. Drawing on Bourdieu's theory of social practice, this paper develops an integrated perspective by observing associations between health and structured lifestyle practices. Using the UK Understanding Society household survey, a taxonomy of eight lifestyle clusters is identified, which exhibit significant health inequalities on a number of indicators. But the plurality of practices and subjective orientations inherent in the taxonomy reveals a finer, more complex differentiation of the social gradient in health. In addition, lifestyle appears to at least in parts mediate the relationship between social, material conditions and health. A feature of the taxonomy is that it admits a relational and contextual apprehension of health‐relevant, behavioural aspects within a more holistic notion of lifestyles. Based on this view, strategic approaches can be developed that respond to group‐specific situations and pathways and their varying roots in upstream or downstream domains of policy. [ABSTRACT FROM AUTHOR]

Abstract Recent health policy renders patients increasingly responsible for managing their health via digital technology such as health apps and online patient platforms. This paper discusses underlying tensions between empowerment and self-discipline embodied in discourses of technological self-care. It presents findings from documentary analysis and interviews with key players in the English digital health context including policy makers, health designers and patient organisations. We show how discourses ascribe to patients an enterprising identity, which is inculcated with economic interests and engenders self-discipline. However, this reading does not capture all implications of technological self-care. A governmentality lens also shows that technological self-care opens up the potential for a de-centring of medical knowledge and its subsequent communalization. The paper contributes to Foucauldian healthcare scholarship by showing how technology could engender agential actions that operate at the margins of an enterprising discourse. Highlights • Digital health policy in UK assumes an enterprising & empowered patient identity. • Tensions between empowerment & discipline occur as patients self-care digitally. • Digital health creates space for agential actions that improve communal health. • A health-making agency operates in the margins of governmental self-care discourse. [ABSTRACT FROM AUTHOR]

Purpose Measuring “impact” is an important aspect of the dissemination of evidence-based practice and relevant to all disciplines. However, it has only recently become a focus of enquiry and is not commonly directly researched within the learning disabilities field. The purpose of this paper is to describe the process of developing a logic model for the UK Positive Behavioural Support (PBS) Academy as part of an evaluation and impact study of its work to date.Design/methodology/approach Logic models are a visual representation of the relationship between a project’s resources, activities and outputs and identified outcomes, in relation to key stakeholder groups. This representation allows for key impact measures to be identified and can be a useful tool for evaluation purposes. The authors used the process outlined by McLaughlin and Jordan (1998) to develop a bespoke logic model for the PBS Academy.Findings The model was particularly helpful in making clear the distinction between output and impact, identifying impact criteria differentiated by stakeholder group and across time scales, and highlighting areas of activity that are needed to increase the impact of the work of the PBS Academy in the longer term.Originality/value In the absence of any generalised impact evaluation frameworks in the learning disabilities field, the authors suggest that logic models may provide a useful framework for evaluating the impact of policy, practice, and research interventions. [ABSTRACT FROM AUTHOR]

Introduction: The cost of treatment and follow-up of cancer patients in the UK is substantial. In a budget-constrained system such as the NHS, it is necessary to consider the cost-effectiveness of the range of management strategies at different points on cancer patients' care pathways to ensure that they provide adequate value for money. Sources of data: We conducted a systematic literature review to explore the cost-effectiveness of follow-up strategies of patients previously treated for cancer with the aim of informing UK policy. All papers that were considered to be economic evaluations in the subject areas described above were extracted. Areas of agreement: The existing literature suggests that intensive followup of patients with colorectal disease is likely to be cost-effective, but the opposite holds for breast cancer. Areas of controversy: Interventions and strategies for follow-up in cancer patients were variable across type of cancer and setting. Drawing general conclusions about the cost-effectiveness of these interventions/strategies is difficult. Growing points: The search identified 2036 references but applying inclusion/exclusion criteria a total of 44 articles were included in the analysis. Breast cancer was the most common (n = 11) cancer type followed by colorectal (n = 10) cancer. In general, there were relatively few studies of cost-effectiveness of follow-up that could influence UK guidance. Where there was evidence, in the most part, NICE guidance broadly reflected this evidence. Areas timely to develop research: In terms of future research around the timing, frequency and composition of follow-ups, this is dependent on the type of cancer being considered. Nevertheless, across most cancers, the possibility of remote follow-up (or testing) by health professionals other than hospital consultants in other settings appears to warrant further work. [ABSTRACT FROM AUTHOR]

Abstract: The notion of recovery has become prominent in mental healthcare discourse in the UK, but it is often considered as if it were a relatively novel notion, and as if it represented an alternative to conventional treatment and intervention. In this paper, we explore some of the origins of the notion of recovery in the early 20th century in movements such as Alcoholics Anonymous and Recovery Inc. Whilst these phenomena are not entirely continuous with recovery in the present day, some important antecedents of the contemporary notion can be detected. These include the focus on the sufferers’ interior space as a key theatre of operations and the reinforcement and consolidation of medical ways of seeing the condition without any immediate medical supervision of the actors being necessary. This has resonance with many contemporary examples of recovery in practice where the art of living with a mental health condition is emphasised without the nature of the psychopathological condition itself being challenged. [ABSTRACT FROM AUTHOR]

Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics. [ABSTRACT FROM PUBLISHER]

As populations rise and many global health policies point towards community care, it is important that health care delivery meets demand. In Ireland, a study was undertaken on the level and context of missed care in community nursing. The study used a survey to identify the quantity of, and reasons for, missed care; a reference group to develop possible health economic implications for missed care, and a small sample of semi-structured interviews to consider the macro-environment within which missed care occurred. This paper presents the findings of the health economics and qualitative data, and the study's implications for community nursing. [ABSTRACT FROM AUTHOR]