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In 1993 the Conference of Royal Colleges and their Faculties called for its members to develop formalized continuing medical education (CME) programmes. Most colleges have adopted a narrow definition of CME and a mechanistic approach to monitoring participation. The Faculty of Public Health Medicine has responded differently by initiating a broader model of continuing professional development (CPD) which emphasizes the individual nature of continuing education. This paper explores the rationale behind this decision. Recent systematic reviews of the effectiveness of CME have demonstrated the need for relevance in any continuing education activity. This means relevance not only to learning needs but also to current work and the applicability of the knowledge. However, the effectiveness of traditional CME for all doctors and particularly public health physicians remains to be established. Thus the Faculty has moved towards a wider context of learning in the form of CPD incorporating an evaluative approach and aspects of adult learning theory. There remains a need for the links between audit and continuing education to be strengthened.

The quality of a multiple true-false (MTF) examination paper in public health medicine for 149 clinical medical students was evaluated using predefined performance criteria to offer guidelines for improvement of such a paper. There were 35 questions, each with five true-false branches, and the performance of the overall best 25% of candidates was compared for individual items with that of the overall worst 25%. To improve discrimination between best and worst candidates, 60% of items needed changes, and several indicators were used to identify how, usually because the branch was too easy (26%), unpopular (16%) or too hard (10%). A number of guidelines for writing good MTF questions and for improving them are suggested. The inequity is illustrated of marking systems which do not allocate a negative mark for incorrect answers equal in size to the positive mark for correct ones, with zero for unanswered questions or 'don't know' answers.

Formal collaboration between epidemiologists, A & E doctors, family practitioners, criminologists and the police is necessary so that criminal justice and public health approaches to the causes and prevention of interpersonal violence can be co-ordinated. Computerized record keeping in A & E departments, incorporating programmes dedicated to assaultive and accidental injury, is an important starting point and this needs to be organized in a systematic way so that comparisons with data collected by police and in national crime surveys can be made. Research is necessary to identify risk groups and to draw causal inferences. Criminal injury is an increasing cause of temporary and permanent handicap and death in many countries and it merits formal epidemiological research, funded by national and international health agencies. This should include the evaluation of primary and secondary prevention programmes in A & E departments and in the community. On the 10th anniversary of the publication of the Black report on inequalities in health, it is apposite to consider that high rates of intentional injury as well as illness are closely linked to poverty and that violence leaves permanent physical and psychological scars. A deprived young urban male may suffer 60 years of incapacity as a result of injury and subsequent further reductions in quality of life and self-esteem. In comparison with child abuse, the causes, identification, prevention and management of assault involving adults are not yet established as a community health issue.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Evidence is needed to support local action to reduce the adverse health impacts of climate change and maximise the health co-benefits of climate action. Focused on England, the study identifies priority areas for research to inform local decision making., Methods: Firstly, potential priority areas for research were identified from a brief review of UK policy documents, and feedback invited from public and policy stakeholders. This included a survey of Directors of Public Health (DsPH) in England, the local government officers responsible for public health. Secondly, rapid reviews of research evidence examined whether there was UK evidence relating to the priorities identified in the survey., Results: The brief policy review pointed to the importance of evidence in two broad areas: (i) community engagement in local level action on the health impacts of climate change and (ii) the economic (cost) implications of such action. The DsPH survey (n = 57) confirmed these priorities. With respect to community engagement, public understanding of climate change's health impacts and the public acceptability of local climate actions were identified as key evidence gaps. With respect to economic implications, the gaps related to evidence on the health and non-health-related costs and benefits of climate action and the short, medium and longer-term budgetary implications of such action, particularly with respect to investments in the built environment. Across both areas, the need for evidence relating to impacts across income groups was highlighted, a point also emphasised by the public involvement panel. The rapid reviews confirmed these evidence gaps (relating to public understanding, public acceptability, economic evaluation and social inequalities). In addition, public and policy stakeholders pointed to other barriers to action, including financial pressures, noting that better evidence is insufficient to enable effective local action., Conclusions: There is limited evidence to inform health-centred local action on climate change. More evidence is required on public perspectives on, and the economic dimensions of, local climate action. Investment in locally focused research is urgently needed if local governments are to develop and implement evidence-based policies to protect public health from climate change and maximise the health co-benefits of local action., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background Mothers who have children removed from their care often have complex needs. These women have poor health outcomes and are dying earlier than their peers from preventable and amenable causes. Yet there is little known about how health care services might mitigate these risks. This study aimed to listen to the voices of women who had children removed from their care to understand their experiences of health and healthcare. Methods We used a narrative approach to collect and analyse interview data with six mothers who had experienced child removal in England. Each participant was asked to reflect on their life and main health challenges. Results Three narrative subplots were developed to consolidate experiences of unmet health need: (i) 'on paper you're normal': narratives of complex need, (ii) 'in my family, everyone had issues': narratives of whole family need and (iii) 'I'm still mummy, no matter where they are': narratives of maternal identity and health. Conclusions Findings highlight limitations within current systems of support, including a culture of distrust and women falling between the gaps of services. Women's narratives illustrate opportunities for health intervention, especially immediately following child removal. [ABSTRACT FROM AUTHOR]

Reports on the efforts of Health Secretary John Reid to publish the book "White Paper" in England. Concerns over the need of reducing the prevalence of obesity in the country; Way of responding to several public health issues; Availability of the book.

Purpose: This study aims to critically examine the effects of COVID-19 social discourses and policy decisions specifically on older adult volunteers in the UK, comparing the responses and their effects in England, Scotland, Wales and Northern Ireland, providing perspectives on effects of policy changes designed to reduce risk of infection as a result of COVID-19, specifically on volunteer involvement of and for older adults, and understand, from the perspectives of volunteer managers, how COVID-19 restrictions had impacted older people's volunteering and situating this within statutory public health policies. Design/methodology/approach: The study uses a critical discourse approach to explore, compare and contrast accounts of volunteering of and for older people in policy, and then compare the discourses within policy documents with the discourses in personal accounts of volunteering in health and social care settings in the four nations of the UK. This paper is co-produced in collaboration with co-authors who have direct experience with volunteer involvement responses and their impact on older people. Findings: The prevailing overall policy approach during the pandemic was that risk of morbidity and mortality to older people was too high to permit them to participate in volunteering activities. Disenfranchising of older people, as exemplified in volunteer involvement, was remarkably uniform across the four nations of the UK. However, the authors find that despite, rather than because of policy changes, older volunteers, as part of, or with the help of, volunteer involving organisations, are taking time to think and to reconsider their involvement and are renewing their volunteer involvement with associated health benefits. Research limitations/implications: Working with participants as co-authors helps to ensure the credibility of results in that there was agreement in the themes identified and the conclusions. A limitation of this study lies in the sampling method, as a convenience sample was used and there is only representation from one organisation in each of the four nations. Originality/value: The paper combines existing knowledge about volunteer involvement of and for older adults. [ABSTRACT FROM AUTHOR]

Background: In the context of substantial financial disinvestment from alcohol and drug treatment services in England, our aim was to review the existing evidence of how such disinvestments have impacted service delivery, uptake, outcomes and broader health and social implications.Methods: We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42020187295), searching bibliographic databases and grey literature. Given that an initial scoping search highlighted a scarcity of evidence specific to substance use treatment, evidence of disinvestment from publicly funded sexual health and smoking cessation services was also included. Data on disinvestment, political contexts and impacts were extracted, analysed, and synthesized thematically.Results: We found 20 eligible papers varying in design and quality including 10 related to alcohol and drugs services, and 10 to broader public health services. The literature provides evidence of sustained disinvestment from alcohol and drug treatment in several countries and a concurrent decline in the quantity and quality of treatment provision, but there was a lack of methodologically rigorous studies investigating the impact of disinvestment.Conclusions: This review identified a paucity of scientific evidence quantifying the impacts of disinvestment on alcohol and drug treatment service delivery and outcomes. As the global economy faces new challenges, a stronger evidence base would enable informed policy decisions that consider the likely public health impacts of continued disinvestment. [ABSTRACT FROM AUTHOR]

The article offers information on the award received by Professor Michael Hebbert from the University of Manchester for his paper "Re-enclosure of the urban picturesque: green-space transformations in postmodern urbanism" as the Best Published Paper 2008 from the Association of European Schools of Planning (AESOP). His appreciated paper is one of a series of essays which focuses on the reconsolidation of urban design while his other works emphasize public health, collective memory, highway design and street architecture and the fundamental concepts of urbanism. The AESOP prize, which started in 1995, is intended to honor deserving scholars and professionals who have exemplary works in the planning field and publishing in planning journals in Europe.

In this paper we argue that to tackle complex issues such as urban health, there is a need not only of understanding the limitation of different policy subsystems, but also of the interplay of the ideas, interests, and institutional arrangements that underpin cross-boundary challenges. This paper unpacks the dynamics of policymaking between public health and spatial planning by adopting boundary-spanning policy regime theory to trace the alignment and divergence of urban health issues across the two policy subsystems in England. Greater Manchester, heralded as an exemplar of collaborative governance in England, is used as a case study to test the strength of and tensions within the urban health policy regime. [ABSTRACT FROM AUTHOR]

Spatially disaggregated estimates provide valuable insights into the nature of a disease. They highlight inequalities, aid public health planning and identify avenues for further research. Spatial microsimulation is advantageous in that it can be used to create large microdata sets with intact microlevel relationships between variables, which allows analysis of relationships between variables locally. This methodological paper outlines the design and validation of a 2-stage static spatial microsimulation model for chronic back pain prevalence across England, suitable for policy modelling. Data used was obtained from the Health Survey for England and the 2011 Census. Microsimulation was performed using SimObesity, a previously validated static deterministic program, and the synthetic chronic back pain microdataset was internally validated. The paper also highlights modelling considerations for researchers embarking on similar work, as well as future directions for research in this area of microsimulation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: It is over 20 years since the publication of the Wanless Report, "Securing our Future Health: Taking a Long-Term View". The Wanless Report argued that the National Health Service (NHS) would survive in its current form only if the population became "fully engaged" with it. Design/methodology/approach: In this discussion paper, the authors explored what "fully engaged" meant to Wanless, what it might mean now (allowing for the impact of the anti-vaxxer movement) and what policymakers could do to enhance public engagement. Findings: Although the Wanless Report neatly fitted into other long-term thinking about the NHS, it was unique in that it built economic models to predict the costs and impact of different patterns of NHS performance. Wanless predicted that people's poor levels of health would put considerable pressure on the NHS. This pressure could swamp efforts to meet healthcare targets and improve health outcomes, despite its sizeable investment of money. Wanless set out three possible scenarios for public engagement with the NHS: solid progress, slow uptake and fully engaged. Practical implications: The authors pose questions for policymakers and practitioners. Would a reboot of the Wanless approach be worth the effort for policymakers? If yes, how would it differ from the original? The NHS faces the whole of society; could it be the vehicle for engaging the anti-vaxxer public with the truthfulness of medical science, and will it be this, that is, Wanless' enduring legacy? Originality/value: The exploration of the Wanless Report is complicated (at least for the time being) by the rise of the anti-vaxxer movement's resistance to health promotion and mistrust of part of the NHS. [ABSTRACT FROM AUTHOR]

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

In 2016, England's National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients' needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR's progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.The NIHR's overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO's recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions. [ABSTRACT FROM AUTHOR]

Background The term 'long COVID' describes ongoing symptoms and conditions experienced by people infected with SARS-CoV-2. This paper illustrates how a public health approach was used to influence and inform the development of post-COVID services across two Integrated Care Systems (ICSs). Methods A literature review was conducted between October and December 2020 to identify prevalence estimates for long COVID. The prevalence estimates were applied to locally available data on the susceptible population to estimate the number of people with long COVID. They were also used to develop a dashboard to predict fluctuations in the number of people experiencing persistent symptoms over time. Results A substantial number of people in each ICS may have experienced persistent symptoms or complications as a result of COVID-19. In Lancashire and South Cumbria, it is estimated that 33 000 people may have experienced post-COVID-19 syndrome since the beginning of the pandemic, which will include respiratory or cardiovascular complications. Conclusions The findings have been valuable in informing early service developments, engaging with managers and clinicians, and supporting applications for funding at a local level. Continued attention to emergent evidence on this topic will be vital in refining estimates and supporting service planning in the longer term. [ABSTRACT FROM AUTHOR]

The article discusses a review on the evaluations of ten initiatives specifically promoted in the National Health Service (NHS) white paper "Our Health, Our Care, Our Say," published in January 2006. An extensive mapping exercise was made to identify evaluations of the specified initiatives being conducted in England. It indicates that the rhetorical commitment to evaluation was compromised and the investment in evaluation at national and local levels was not as productive.

Purpose: There are significant health inequalities experienced by women in prison. They face distinct challenges and have particular and complex needs, specifically with regard to their physical and mental health. The purpose of this paper is to describe the approach taken to develop a set of health and wellbeing standards for the women's prison estate in England, which can be applied elsewhere.Design/methodology/approach: A structured literature review of standard healthcare databases and grey literature was used to inform development of suggested standards. A multidisciplinary expert panel provided consensus on the standards through an online survey and women with a history of contact with the criminal justice system were consulted through consensus groups.Findings: A total of 549 papers were included in the final review. From this, 127 standards were identified for inclusion in the Delphi process. Consensus was achieved on all standards; this, combined with the analysis of qualitative feedback provided by both the survey and the consensus groups, resulted in the development of 6 overarching principles and 122 standards, across ten topic areas.Originality/value: These standards are the most extensive that are known to exist for health and wellbeing of women in prison and the first to be developed in England. The process used ensures the standards have high validity, acceptability and feasibility and can be used to support those developing similar methodologies. There are few papers which document the development of standards to improve health and to the authors knowledge, only one other paper has been published detailing the development of health standards in prison settings specifically. [ABSTRACT FROM AUTHOR]

Purpose: This paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of "Public Health" is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the "facts" when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable. Design/methodology/approach: The theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis. Findings: The paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing "alternative accounts" and "intelligent accountabilities" through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential. Originality/value: Few studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable. [ABSTRACT FROM AUTHOR]

Governments in many countries are increasingly interested in using community sport as a vehicle for improving public health through physical activity (PA) promotion. This has been associated with an increasing interdependence between the community sport and health policy sectors. However, there are no empirically grounded studies which have examined this directly and systematically in England. By examining Sport England's Get Healthy, Get Active (GHGA) initiative, this paper presents novel evidence derived from interviews held with strategic policy-makers from Sport England and a professional football charity (Everton in the Community), and 67 men who engaged in one of the GHGA funded programmes, Active Blues. The findings reveal how the increasing interdependence between community sport and health policy has been characterised by tightly contested and congested relations of power at local and national levels. Although Sport England was the lead organisation which coordinated and was accountable for community sport, it was nevertheless highly dependent on organisations outside of the sector, including health organisations, to deliver their community sport goals. This was indicative of the relatively vulnerable and marginal position which Sport England, and sport policy, occupied in the policy landscape and the associated generalisation of interests from sport to public health. The policy spillover from more powerful policy sectors such as health, to comparatively less powerful ones like community sport, raises questions about the degree to which government can realistically expect to achieve their formal community sport and health policy goals. [ABSTRACT FROM AUTHOR]

In April 2013 the local public health function in England was returned from the National Health Service (NHS) to local government, reversing the transfer to the NHS made in 1974 with the abolition of the medical officer of health. Although many in the field had long felt that local government was the appropriate home for public health given its wide-ranging responsibilities for the social determinants of health, the timing was poor. Local government was in the third year of what continued to be an unprecedented ten-year period of austerity imposed by central government with cumulative cuts of the order of 40% for many local authorities. And despite an initial commitment to a ring-fenced public health grant, this grant has been cut each year since 2015–2016 in addition to the wider local authority funding cuts which have had inevitable knock-on effects on the public health function. Crucial public health services such as early years, smoking cessation and sexual health services have all been cut. Despite these cuts the UK government continues to claim a commitment to improving public health and tackling inequalities in health. This study examines the government's discourse on funding local public health services, and the ways in which it has responded to critics through a detailed documentary analysis of key government white papers, ministerial statements and its responses to criticisms, particularly from parliamentary select committees and professional bodies. The paper concludes by considering the implications for effective local public health action in a national regime of austerity. [ABSTRACT FROM AUTHOR]

Introduction: The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. Methods: This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model. Results: The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty. Conclusions: The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health. [ABSTRACT FROM AUTHOR]

Health visiting has been described as the backbone of early years services across the UK and the safety net around all families. This paper explores the role of health visitors and the current context in England. Health visitors lead and deliver the Healthy Child Programme which is the national preventative public health programme covering pregnancy and the first five years of life. It aims to ensure that every child has the best start in life, regardless of where they live. With child health deteriorating, more children falling behind with their development, growing concerns about invisible vulnerable children, widening inequalities and soaring costs of late intervention, there is a clear imperative to act. Health visitors provide an important part of the solution; however, the service is facing significant challenges. When sufficiently resourced, health visitors play a crucial role in ensuring that families get good, joined up support – preventing, identifying and treating problems before they reach crisis point. The benefits of an effective health visiting service accrue to numerous government departments, contributing to a whole system response to address a multitude of policy priorities for babies, children and families across health, education and social care. [ABSTRACT FROM AUTHOR]

As one might expect after the formation of a new government, there has been a considerable amount of activity on the policy front in recent months, with a range of green and white papers and other consultations. In this article, we summarise just four areas of policy development that will primarily impact in England: the drug strategy, the mental health strategy, the public health White Paper and the Breaking the Cycle green paper on sentencing and rehabilitation. [ABSTRACT FROM AUTHOR]

As the new Cell-free DNA (Cf-DNA) prenatal screening test for Down syndrome was being introduced into the UK's fetal anomaly screening program, Down syndrome charities had an opportunity to participate. An experience of co-production where we were the minority voice then followed. This paper explores that process and our experience as a charity. Institutional and societal structures meant that it was difficult to be heard and a significant amount of bias was noted within the program. Consequently, our viewpoints were often considered and then dismissed. However, at times we were listened to, and feel that there were some valuable changes made resulting from our involvement. The end product was far from reflective of all that we stand for, and there are still lessons to be learned in England about the need to place a higher value on minority voices of lived experience in a co-production exercise. [ABSTRACT FROM AUTHOR]

Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action. This paper addresses these developments, and specifically engages with the contested notion of 'allyship'. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation. White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity. The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings. [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration accounts for the majority of severe sight impairment and sight impairment registration and certifications in adults in the UK [1, 2]. Whilst these treatments are effective in arresting nAMD progression, there is currently no treatment for GA [1, 3, 4]., Methods: This paper provides an update to the data collected by Bunce et al. [3] and details the number of people certified together with incidence rates for the various types of AMD by: sex, sight impairment status, and for all ages using the 2016/2017 and 2017/2018 CVI due to AMD data for England from the Moorfields Eye Hospital, supplemented with 2017-2018 PHOF indicator 4.12i/E12a data. The study population includes individuals of all ages in England who were newly certified with visual impairment due to AMD., Results: Between 2016 and 2017, CVIs due to AMD totalled to 11,215; between 2017 and 2018, CVIs due to AMD totalled to 10,914. The PHOF indicator 4.12i/E12a assessed showed that overall rates of AMD certifications have steadily declined in England from 131.5 per 100,000 in 2010/2011 to 106.7 per 100,000 in 2017/2018., Conclusion: As treatment is available for nAMD, a reduction in nAMD certifications could be expected; however, growth of the elderly population in England combined with there currently being no treatment available for GA means AMD certification rates should be increasing. Therefore, it is postulated that not all cases of AMD are being certified and registered with some likely going undiagnosed., (© 2022. The Author(s).)

Purpose: The purpose of this paper is to explore the outcomes identified by the evaluation of the national programme of integrated care pilots (ICPs) in England in the context of wider policies designed to deliver integrated care and to consider the challenges presented to policy makers and evaluators in distilling usable insights to promote effective policy. Design/methodology/approach: This is a review of the ICP evaluation findings and the findings of a number of systematic reviews into aspects of integrated care. This paper shows the contextual analysis of these findings in relation to health policy in England. Findings: The evaluation of ICPs in 2012 produced mixed results with some potentially useful findings for policy makers. However, numerous integrated care initiatives succeeded the ICPs suggesting that insights from evaluation are of limited usefulness to policy makers or are difficult to implement. A shift in macro policy within the English NHS may support integrated care by aligning objectives of clinical teams with those of the wider systems within which they operate. Research limitations/implications: This review has not been based on a systematic review of the evidence on integrated care and reflects the personal experiences and views of the authors who have been active in this field of research for many years. Originality/value: This paper considers why evaluation findings appear limited in their impact on policy in the field of integrated care. Views as to how evaluation might be undertaken so that it generates actionable insights are advanced. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of the goals of “population health”. The authors examine evidence from earlier initiatives to achieve similar objectives of primary care-led health system planning and care integration to understand relevant lessons for the PCH.Design/methodology/approach This paper is based on a descriptive review of the PCH using documentary sources and a non-systematic review of literature relating to primary care commissioning initiatives and recent initiatives to deliver general practice services on a larger scale.Findings The PCH is likely to bring forth relatively high engagement from general practitioners due to its neighbourhood scale, voluntary nature and its focus on professional partnership, personalisation of care and outcomes. It is important that participants have sufficient autonomy to act and that financial incentives are aligned with the goals of population health. It is also important that, unlike some earlier primary care initiatives, the PCH is given time to develop to maturity.Originality/value The PCH is a recent phenomenon that is developing in England and elsewhere. This paper locates the PCH within a historical context and draws conclusions from a relevant evidence base. [ABSTRACT FROM AUTHOR]

In January 2021, we assessed the implications of temporary regulations in the United Kingdom allowing pubs and restaurants to operate on a takeaway basis without instigating a change of use. Local authorities (LAs) across the North‐East of England were unaware of any data regarding the take‐up of these regulations, partially due to ongoing capacity issues; participants also raised health concerns around takeaway use increasing significantly. One year on, we repeated the study aiming to understand the impact of these regulations on the policy and practice of key professional groups. Specifically, we wanted to understand if LAs were still struggling with staff capacity to address the regulations, whether professionals still had public health trepidations, and if any unexpected changes had occurred across the local food environment because of the pandemic. We conversed with 16 public health professionals, planners and environmental health officers across seven LAs throughout the North‐East of England via focus groups and interviews. Data collated were analysed via an inductive and semantic, reflexive‐thematic approach. Through analysis of the data, three themes were generated and are discussed throughout: popular online delivery services as a mediator to increased takeaway usage; potential long‐term health implications and challenges; continued uncertainty regarding the temporary regulations. This paper highlights important changes to local food environments, which public health professionals should be aware of, so they are better equipped to tackle health inequalities across urban and sub‐urban areas. [ABSTRACT FROM AUTHOR]

Women doctors in public health were able to achieve consultant status, and major strategic leadership roles, well ahead of female colleagues in other areas of medical and, especially, surgical practice. This development was bound up with the struggles in the early days of the Faculty of Community Medicine to achieve its status as a separate Faculty of the Royal College of Physicians, raise standards and encourage able and committed doctors to join the specialty. This paper outlines the history of public health medicine in England between 1974 and the 1990s when, through a combination of design, and happenstance in response to organizational changes, a gender-neutral specialty was created, benefiting both men and women, and enabling the latter, in particular, to flourish., (© The Author(s) 2022. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background Valuable learning derived from public health practice can be captured through practice-based case studies, also known as practice examples. Practice examples of participatory interventions supplement the evidence base by providing information on the complexities of implementation in communities. This paper reports on a Public Health England project to build a bank of community-centered practice examples based on robust processes of collection and curation. Methods The multidisciplinary project had three phases: (i) development and piloting a process to collect practice examples, (ii) refining review processes and gathering further examples via national and regional teams (iii) maintenance of an accessible collection on the library platform. Results The project resulted in a searchable collection of 55 practice examples illustrating participatory approaches in public health practice. The collection shows diversity in terms of settings, population, focus and type of approach used to work with communities. A secondary outcome was the development of generic guidance and templates for further collections on public health topics. Conclusions This project illustrates how information on the implementation of community-centered approaches in real-life contexts can be gathered and disseminated through a transferable process. Having collections of practice examples supports knowledge exchange in public health as learning is shared. [ABSTRACT FROM AUTHOR]

Purpose: Public mental health training can effectively support well-being at a population level. The application of this type of training is increasingly prevalent, however, training evaluation is currently limited and inconsistent. This paper aims to summarise the characteristics of public mental health training available in England, presents key quality criteria for this training and identifies gaps in training provision. Design/methodology/approach: This paper uses a pragmatic mixed-methods approach including database and Google Searches, focus groups and survey methods. The data analysis included a structured data extraction template for the training availability scoping and thematic analysis of the survey and focus groups. Findings: This paper identifies a total of 74 training courses targeting workplace employees, young people and the general population. Most courses were delivered face-to-face (54), followed by e-learning (16) and blended modalities (4). This paper derives four core quality principles, focussing on the training approach, key features of training, trainer attributes and evaluation. There were no significant gaps in training provision, although areas for future development included consistency in public mental health terminology, systems and populations requiring additional training and the logistics of training delivery, etc. Originality/value: The results contribute to the evidence base of interventions that are currently available, supporting the efforts to evaluate the impact of training provision in this area. This paper provides a novel approach to assessing training quality and discuss areas for development and innovation in this field. [ABSTRACT FROM AUTHOR]

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health.)

The article reports on a White Paper on care outside of hospitals in England that will be published at the end of 2005 or early in 2006. The potential impact of the document is revealed. The document will be about community health and care services and it will be a combined health and social care paper. The consultation process by which the paper is being developed is deliberative involving regional and national events with the public entitled "Your Health Your Care Your Say."

Presents an editorial on public health. Description of a white paper called "Choosing Health: making healthy choices," that presents the English government's approach to tackling a broad range of public health challenges from smoking, obesity, and drinking to mental and sexual health; Need for several points to be considered in order for this approach to work; How the white paper fails to address the inequalities that purport to be the driving force behind it; Reluctance of the government to take its own medicine.

Aims: The United Kingdom and Australia have developed highly divergent policy responses to electronic nicotine delivery systems (ENDS). To understand the historical origins of these differences, we describe the history of tobacco control in each country and the key roles played in setting ENDS policy in its early stages by public health regulations and policy networks, anti‐smoking organizations, 'vaper' activist networks and advocates of harm reduction policies towards injecting drug use. Methods: We analysed key government reports, policy statements from public health bodies and non‐government organizations (e.g. cancer councils and medical organizations) on ENDS; submissions to an Australian parliamentary inquiry; media coverage of policy debates in medical journals; and the history of tobacco control policy in Australia and England. Key discourses about ENDS were identified for each country. These were compared across countries during a multi‐day face‐to‐face meeting, where consensus was reached on the key commonalities and divergences in historical approaches to nicotine policy. This paper focuses on England, as different policy responses were apparent in constituent countries of the United Kingdom, and Scotland in particular. Results: Policymakers in Australia and England differ markedly in the priority that they have given to using ENDS to promote smoking cessation or restricting smokers' access to prevent uptake among young people. In understanding the origins of these divergent responses, we identified the following key differences between the two countries' approaches to nicotine regulation: an influential scientific network that favoured nicotine harm reduction in the United Kingdom and the absence of such a network in Australia; the success of different types of health activism both in England and in Europe in opposing more restrictive policies; and the greater influence on policy in England of the field of illicit drug harm reduction. Conclusions: An understanding of the different policy responses to electronic nicotine delivery systems (ENDS) in England and Australia requires an appreciation of how actors within the different policy structures, scientific networks and activist organizations in each country and region have interpreted the evidence and the priority that policymakers have given to the competing goals of preventing adolescent uptake and encouraging smokers to use ENDS to quit smoking. [ABSTRACT FROM AUTHOR]

Women experiencing three or more co-occurring issues (homelessness, substance misuse, mental health) are a highly vulnerable population associated with multimorbidity. Taking women's life stories of trajectories into social exclusion in the north of England as its focus, this paper aims to explore the complexity of social contexts in which women navigate extreme health inequalities. Of the few studies that have examined women's experiences of homelessness through the lens of social capital, most have focused on network size, rather than the quality and influence of the relationships which precipitate or contextualise experiences of social exclusion. We utilise case studies to offer a theoretically-grounded analysis which illustrates the relationship between social capital and homelessness within this population. Our results illustrate how structural contexts, and specifically social capital accrual and social bonding processes particularly pertinent to women can act to both ameliorate and perpetuate social exclusion. We conclude by arguing that health inequalities cannot be tackled as single-issue processes but instead are multi-layered and complex. [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]

Purpose The NHS needs to adapt as never before to maintain and plan for an integrated and sustainable multi-professional workforce, spanning all health and care sectors. This cannot happen without system leaders embracing workforce transformation at scale and enabling system-wide collaboration and support for multi-professional learning and role development. "By learning together, we learn how to work together". The paper aims to discuss these issues.Design/methodology/approach The case studies included in this paper provide evidence of the ability of NHS systems to adopt integrated workforce models at scale. The case studies were chosen to demonstrate how system-wide change is possible, but still requires a partnership approach to innovation, strategic workforce planning and commissioner support for new models of care.Findings With partnership working between arm's length bodies, commissioners, educators and workforce planners, the NHS is more than capable of generating a transformed workforce; a workforce able to continue providing safe, effective and joined-up person-centred care.Research limitations/implications The focus of this paper is integrated workforce development undertaken by Health Education England from 2017 to the date of drafting. The case studies within this paper relate to England only and are a cross-section chosen by the authors as a representative of Health Education England activity.Practical implications The NHS needs to find ways to use the wider health and care workforce to manage an ever-increasing and diverse patient population. Silo working, traditional models of workforce planning and commissioning no longer provide an appropriate response to increasing patient need and complexity.Social implications The evolution of the NHS into a joined-up, integrated health and social care workforce is essential to meet the aspirations of national policy and local workforce need – to centre care holistically on the needs of patients and populations and blur the boundaries between primary and secondary care; health and social care; physical and mental health.Originality/value This paper contains Health Education England project work and outcomes which are original and as yet unpublished. [ABSTRACT FROM AUTHOR]

RCN says school nurses are central to public health improvements. [ABSTRACT FROM AUTHOR]

Community gardening is increasingly framed and promoted as a way to foster healthful behaviours, as a wellbeing practice, and as a public health tool. This paper draws on semi-structured interviews with community gardening organisers (n = 9) in the North East of England, who were engaged in translating and transforming discourses and ideas about community gardening into places and practices that people can draw benefit from. Here, community gardening can be understood as a bricolage of ideas, resources, and skills at the nexus of several influences and movements, assembled to produce a localised, everyday sort of social change. We conclude that framing community gardening as a simple solution to be harnessed in the promotion of health and wellbeing undermines the richness that sustains it and may lead to disenchantment within health services and community gardening organisations that could threaten the future of 'green social prescribing'., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Drawing on testimonies from oral history interviews with HIV/AIDS community activists and PrEP users, this paper analyses new forms of collective action in relation to the efforts to implement PrEP in England. The analysis of this PrEP response, delivered by an assemblage of independent actors and public health-related agents exposes three important aspects in relation to the lived experiences of first-wave PrEP users and HIV activists: (i) the negotiation of PrEP as a medical commodity, (ii) the use of gay dating apps as enabling technologies in regard to peer support, and (iii) the fact that access to PrEP was not equally distributed and differed between gay communities. This paper concludes that although this response was effective in decreasing HIV infection, it was only partially transformative in terms of social/health justice. However, the response featured forms of collective action that contrasted with the individualistic paradigm of the biomedicalisation of HIV prevention, pointing to a shift in future HIV prevention interventions. [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]

Extreme weather alerting systems are one of the central tools utilised in adapting to changing weather patterns resulting from climate change. This paper evaluates the effectiveness of the current alerting systems for hot and cold weather used in England to notify the health and social care sector of upcoming extreme weather events. We consider the views of stakeholders on the current system and explore their perspectives on the proposal to move towards an impact-based system. The paper concludes that while the current system is an effective tool, stakeholders feel they need to draw on additional material to assist with the development of an appropriate response. We also highlight that many stakeholders are concerned about the potential for creating alert fatigue due to a lack of clarity of the geographical area impact of some of the alerts. Consequently, there was a high level of support from stakeholders for the move towards an impact-focused system. • Extreme weather alerting systems are an important tool for protecting public health. • Impact-focused alerting systems can help planners and front-line staff deliver a more effective response to extreme weather. • It is important alerts are not sent out unnecessarily to protect the credibility of the system and avoid alert fatigue. [ABSTRACT FROM AUTHOR]

England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms. [ABSTRACT FROM AUTHOR]

Background In April 2020, Covid-19 brought NHS elective procedures to a halt. The aim of this paper is to produce accurate forecasts on the building backlog, highlight the state of waiting lists currently and propose solutions required to prevent a public health crisis. Method Using data published by NHS digital and NHS England on previous years, we have analysed and used this to produce estimates of cancellations and missed cases. We also analyse government data on waiting lists and show compliance or lack of with these. Results We show that compliance with waiting list times pre pandemic was falling year on year (83.2% in 2020 down from 87% in 2019). Every month that passes we estimate that 400 000 cases are not being performed. This may include urgent cancer care work in some trusts. Conclusions Waiting lists have been governed by strict rules since 2004. Given falling compliance with 18-week intention to treat we believe the scale of the backlog combined with NHS capacity diminished due to Covid-19 precautions is a public health crisis waiting to occur. We identify difficulties in resuming elective work and suggest strategies that could be employed to avoid a public health crisis. [ABSTRACT FROM AUTHOR]

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

This paper describes a 9-month project commissioned by Halton Clinical Commissioning Group (CCG) and Liverpool photography organisation, Open Eye Gallery. Socially engaged photographers worked with local residents from the Windmill Hill estate in Runcorn to describe healthy and unhealthy aspects of the area. Six women were trained to use cameras to document everyday things that mattered to them. Through focus groups they discussed what these photographs revealed about the health and ill-health of the area. The resulting exhibition, As and When, told their story. Despite being a deprived area with more than average incidence of illness, they identified many positive things that enhanced their sense of wellbeing and resilience. The benefits of the project included increased social engagement and participation, an improved sense of vitality and rejuvenation, emotional benefits, a feeling of greater political agency and increased visual literacy. This paper outlines the model of practice developed with the support of CCG and in collaboration with local stakeholders. It makes a case for the value and the ways in which clusters of general practices could develop links and work with health assets in their local communities. [ABSTRACT FROM AUTHOR]

Making Every Contact Count (MECC) is a national, long‐term public health strategy in England. It supports public‐facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under‐represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi‐stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi‐structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self‐reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels—national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a 'double‐edged sword,' in light of associated challenges such as sector‐level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long‐term sustainability challenges. The recommendations call for system‐level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes—particularly in relation to seldom‐heard client groups. [ABSTRACT FROM AUTHOR]

This study explores the experiences of professionals who worked with care home residents with impaired mental capacity in England and Wales during the COVID‐19 pandemic. It explores (i) how competing risks were balanced and (ii) how the Mental Capacity Act (MCA) functioned in care homes under pandemic conditions, with particular focus on its associated Deprivations of Liberty Safeguards (DoLS) and Independent Mental Capacity Advocacy (IMCA) systems. Between March and May 2021, we held an online survey and five focus groups aimed at professionals who worked in or with care homes during the pandemic. The study explored issues pertaining to residents with impaired mental capacity, alongside several other topics on which we report elsewhere. For this paper, we filtered data to only include responses from 'capacity professionals'. The resulting sample comprised 120 (out of 266) survey participants and 18 (out of 22) focus group participants. We performed manifest content analysis on the filtered data and found that (1) participants reported a 'massive discrepancy' between the ways different care homes balanced the risk of COVID‐19 infection with the risks associated with severe restrictions. (2) Some suggested this was due to vague guidance, as well as care home type and size. Participants told us the pandemic (3) obstructed smooth operation of statutory safeguards designed to protect residents' human rights and (4) resulted in confusion about the remit of the MCA during a public health crisis. Our findings raise concerns about the impact of pandemic‐related measures upon care home residents with impaired mental capacity. We urge further exploration and analysis of (a) the variability and inconsistency of restrictions applied at care homes, (b) the strain placed on key safeguards associated with the MCA, (c) uncertainty about the remit of the MCA during a public health crisis and (d) the human rights implications hereof. [ABSTRACT FROM AUTHOR]