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Background: The Ambitions for Palliative and End of Life Care is a national framework for local action in England co-produced by over 30 partners; little research has been conducted on how the Framework is received and used. This study sought to examine and support how people understand, interpret, and implement the Framework. Methods: A multi-stage qualitative methodology involving four stages of data collection: (1) case study interviews, (2) focus groups, (3) interactive workshops, and (4) Evidence Cafés. From initial interviews, ongoing thematic data analysis informed the design and focus of subsequent stages as part of a process of knowledge transfer. Results: A practical resource to support service provision and development was produced; a grab-and-go guide called "Small Steps, Big Visions". It focuses on the eight foundations in the Ambitions Framework, with additional guidance on collaboration and partnership working, and sharing learning. Each foundation is presented with a 'what' (definition), 'ask' (prompt questions), and 'examples in action' (drawn from case studies). Conclusions: Research can contribute to policy implementation to advance palliative and end of life care. The engagement and input of those responsible for implementation is key. [ABSTRACT FROM AUTHOR]

The planning system in England is regarded as a key mechanism for the delivery of housing but is also seen by some as a brake on its supply. In this context, the introduction of neighbourhood planning in 2011 has been promoted as a mechanism to reduce opposition to new housing and aid housing growth. This paper focuses on how this policy tool has been implemented with a view to mobilising communities to assist in the allocation of housing sites. The paper draws on empirical data to illustrate the role, motivations, and response to neighbourhood planning and its impact on the delivery of housing. [ABSTRACT FROM AUTHOR]

Objective: A new patient safety policy, 'Learning from Deaths' (LfD), was implemented in 2017 in National Health Service (NHS) organisations in England. This study examined how contextual factors influenced the implementation of LfD policy and the ability of the programme to achieve its goals. Methods: Semi-structured interviews were undertaken with key policymakers involved in the development of the policy, along with interviews with managers and senior clinicians in five NHS organisations responsible for implementing the policy at the local level. We also undertook non-participant observation of relevant meetings and documentary reviews of key organisation procedures and policies pertaining to LfD. Results: The study findings suggest several factors that hinder or support patient safety policy implementation at a local level. These include: (a) an organisation's capacity and capability to support data collation, analysis and synthesis, (b) the dissemination of the resulting information, (c) the learning culture and hence perceptions of the purpose of LfD within an organisation, and (d) the extent of engagement in cross-organisational approaches to learning. Conclusions: Extra and intra-organisational contextual factors influence all stages of the policy implementation process from preparation and tracking to implementation support and review affecting its chances of success or failure. Successful adoption of a national patient safety policy within health care organisations can be informed by taking into consideration those factors. [ABSTRACT FROM AUTHOR]

Purpose: Sustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances. Design/methodology/approach: Documentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically. Findings: The study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress. Research limitations/implications: The findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs. Originality/value: This study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. Design/methodology/approach: This paper aims to present a thematic synthesis of mental health policies published in England from 1999 to 2020. The authors specifically focus on ethnicity-related mental health issues highlighted in policies, policy recommendations and performance measurements of policy implementation. Findings: Findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the past two decades. Ongoing issues include a lack of data on the ethnicity of mental health services users. Where data is available, these highlight ethnic inequalities in access to, experiences of and outcomes of mental health services, as well as a lack of cultural capability in health-care professionals. Policy recommendations have also remained the same during this time and include: collecting data on the ethnicity of service users, raising awareness of the cultural needs of Black and Minority ethnic populations amongst health-care professionals, recruiting BME staff into mental health care services and improving community engagement. The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Practical implications: The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Originality/value: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. [ABSTRACT FROM AUTHOR]

Policy driven change is challenging, with a significant gap between theory and practice. A key tension in enacting such change is achieving a balance between bottom-up development of local, context-specific approaches, and top-down, centrally determined policy solutions and their mutual sequencing. Ideal type models of the policy-making process envisage a rational ordered approach, driven by evidence and accompanied by ongoing evaluation of outcomes (Parsons, 1995, p77); however, the reality is far more complex. We examine the implementation and early operation of the New Care Models (NCM) Vanguard programme in England, using Matland's (1995) ambiguity-conflict model, to explore the aims and expectations of the programme. We consider the relationship between top-down and bottom-up approaches to policy development and draw attention to the pressures coming from what was initially perceived as a permissive policy approach of encouraging experimentation, whilst also requiring rapid learning, scale and spread. We suggest that future programmes for large-scale policy implementation initiatives could be crafted differently to take account of the environment of implementation and render ambitions more realistic. Rather than aiming to create a set of definite products and templates, it may be that a set of principles for design and implementation should be developed and spread. [ABSTRACT FROM AUTHOR]

This policy analysis examines the impact of COVID-19 policy guidance on the role of workers who provide outreach to transition-age care leavers. The comparison focuses on four countries (US, England, Canada, Australia) and addresses the question: How do policy changes impact street-level bureaucracy (SLB) discretion, activities, resources, and constraints? A review of policy guidance identifies similar actions across the four countries focused on: public health measures, extension and flexibility of services, prioritization of cases, and enhanced use of technology. Extension and flexibility of services were particularly noted. Cautions about the temporary nature of these changes are identified.Note: In the interests of space, street-level theory and the pandemic context underpinning the articles for this Special Issue are discussed in detail in the Introduction to the Issue. [ABSTRACT FROM AUTHOR]

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]

Accessible summary What is known on the subject? People with mental health problems and learning disabilities often do not receive the care they require., The Care Programme Approach ( CPA) is meant to help with this. However, there have been many problems in the past with the introduction of the CPA into mental health services., There is no literature which explores what factors help or hinder the introduction of the CPA for service users with a mental health and learning disability, especially from the perspective of those responsible for overseeing this process., What does this article add to existing knowledge? The implementation of the CPA for this service user group is fragmented, and services are not working together in partnership., The CPA is being effectively implemented for people who are deemed to present with a risk to themselves or others. If a service user does not present with a high risk, they are not provided care through the CPA., Service users were not involved in the development or introduction of the policy in practice., What are the implications for practice? Services need to work better at engaging service users when they are developing and introducing new policies., Rather than applying the CPA for all service users, across all services, it should only be considered for those deemed to present with a high risk. It is effectively implemented for these people., For those not deemed to present with a high risk, services should consider using alternative service user led care planning frameworks., Abstract Introduction The Care Programme Approach was introduced in England to ensure services met the needs of people with mental health problems and a concurrent learning disability (dual diagnosis). The CPA implementation was patchy and services failed to work in partnership. Aim This study aimed to explore the factors shaping the recent implementation of the CPA for service users with a dual diagnosis. Method A single case study approach was undertaken. Data were collected through interview ( n = 26), documentary analysis ( n = 64), steering group observation ( n = 3) and the Partnership Assessment Tool ( n = 26). Data were analysed using the Framework Approach. Results The CPA was only effectively implemented for people who were deemed to present with a high level of risk. Discussion The problems associated with implementation in the 1990s continue more recently for those with a dual diagnosis. The CPA has become more aligned with risk management protocols than supporting individual service user's recovery. Implications for practice Service users should be involved in the implementation of policies which have an impact on their recovery. The CPA should only be applied for those who present with high-risk issues, whilst alternative user-led initiatives should be considered for other service users. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to discuss the different meanings of integration as expressed in dementia care practice and service organisation in England. Dementia is frequently complicated by concurrent illnesses or long-term conditions at the end of life. Design/methodology/approach - This is a policy discussion. Findings - The paper describes three forms of integration: linkage, co-ordination of care, and full integration. Each form or level is related to dementia as a progressive neurological disorder with multiple symptoms, which also overlaps with other long-term conditions, making each individual's dementia unique. Linkage means being able to identify appropriate resources to meet the needs of the individual and their family. Co-ordination usually means multi-disciplinary working at least with general practice and often wider practitioner input. Full integration is best expressed by the work of care homes, which co-ordinate care and often draws on diverse funding streams. Practical implications - Greater specificity of the meaning of integration may be helpful to policy makers and practitioners. The care and treatment of people with dementia may be optimised if practitioners think about work styles and engagement with other sectors, agencies and professionals rather than pursuing all-encompassing organisational integration. Care homes may have much to teach other practice settings about full integration. Originality/value - Integration is often seen uncritically as the solution to all problems; this paper explores the varieties of integration and explores their implications for practitioners and policy makers supporting people with dementia and their carers. [ABSTRACT FROM AUTHOR]

Adult safeguarding is the subject of increasing attention in England and internationally. This article draws on research which developed a typology of 'models of safeguarding'. 'Models' refer to different ways local authorities in England organise adult safeguarding (about which there is little evidence) rather than 'model' approaches to be emulated. The four models identified were: Dispersed-Generic (safeguarding work undertaken by operational teams); Dispersed-Specialist (safeguarding work undertaken partly by specialist social workers located in operational teams); Partially Centralised-Specialist (some safeguarding work undertaken by a central specialist safeguarding team); and Fully-Centralised-Specialist (all safeguarding work undertaken by a specialist safeguarding team). We explored associations between these models and other important variables (numbers of referrals, kinds of alleged abuse and characteristics of adults at risk) and outcomes. The article reports secondary analysis of English local authority safeguarding referral data and on the possible different costs of different models. Dispersed-Specialist sites appeared to have a higher rate of substantiating alleged abuse compared with other models. Statistical correlations were found with types of victim profiles and the perpetrator/victim relationship. It may be that decisions about local organisation of safe-guarding are more affected by local organisational contexts than local authority model. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the implementation of learning disability (LD) policy among LD commissioners and managers in Kent (South East England) and a neighbouring area.Design/methodology/approach Participants’ views were elicited by semi-structured interviews focussed on two key national policy documents: Valuing People (DH, 2001) and the Mansell report (DH, 1993; 2007a).Findings Valuing People had a significant impact at the time of publication but initial enthusiasm and impetus faded over time. The Mansell report was thought to have had little impact on local services. Good progress was reported with respect to the development of more integrated services. Limited progress was identified with respect to the development of local mental health and challenging behaviour services. Factors influencing policy implementation were identified.Originality/value The similarity of findings to those of McGill et al. (2010) suggest their more general relevance. In the light of the subsequent investigation into Winterbourne View, common themes from both studies are considered in relation to the current Transforming Care programme in England. [ABSTRACT FROM AUTHOR]

Public Involvement (PI) is a strategic priority in global healthcare settings, yet can be seen as peripheral during decision making processes. Whilst extant research acknowledges variations in how policy is translated into practice, the majority attribute it to the limiting influence of professional hierarchies on the perceived ‘legitimacy’ of PI. Drawing on examples of three commissioning organisations within the English NHS, we outline how the variance in policy implementation for PI can be attributed to influence from the managers rather than professionals. In doing so we explore how rational ideologies of managerial control negatively impact PI. However, we also illustrate how PI alluded to in policy can be more successfully realised when organisational managers enact normative ideologies of control. Notwithstanding this assertion, we argue managerial domination exists even in the case of normative ideologies of control, to the detriment of more radical PI in service development. [ABSTRACT FROM AUTHOR]

Inequitable healthcare access, experiences and outcomes across ethnic groups are of concern across many countries. Progress on this agenda appears limited in England given the apparently strong legal and policy framework. This disjuncture raises questions about how central government policy is translated into local services. Healthcare commissioning organisations are a potentially powerful influence on services, but have rarely been examined from an equity perspective. We undertook a mixed method exploration of English Primary Care Trust (PCT) commissioning in 2010–12, to identify barriers and enablers to commissioning that addresses ethnic healthcare inequities, employing:- in-depth interviews with 19 national Key Informants; documentation of 10 good practice examples; detailed case studies of three PCTs (70+ interviews; extensive observational work and documentary analysis); three national stakeholder workshops. We found limited and patchy attention to ethnic diversity and inequity within English healthcare commissioning. Marginalization of this agenda, along with ambivalence, a lack of clarity and limited confidence, perpetuated a reinforcing inter-play between individual managers, their organisational setting and the wider policy context. Despite the apparent contrary indications, ethnic equity was a peripheral concern within national healthcare policy; poorly aligned with other more dominant agendas. Locally, consideration of ethnicity was often treated as a matter of legal compliance rather than integral to understanding and meeting healthcare needs. Many managers and teams did not consider tackling ethnic healthcare inequities to be part-and-parcel of their job, lacked confidence and skills to do so, and questioned the legitimacy of such work. Our findings indicate the need to enhance the skills, confidence and competence of individual managers and commissioning teams and to improve organizational structures and processes that support attention to ethnic inequity. Greater political will and clearer national direction is also required to produce the system change needed to embed action on ethnic inequity within healthcare commissioning. [ABSTRACT FROM AUTHOR]

Context In 2004, the English Public Health White Paper Choosing Health introduced 'health trainers' as new members of the National Health Service (NHS) workforce. Health trainers would offer one-to-one peer-support to anyone who wished to adopt and maintain a healthier lifestyle. Choosing Health implicitly envisaged health trainers working in community settings in order to engage 'hard-to-reach' individuals and other groups who often have the poorest health but who engage the least with traditional health promotion and other NHS services. Methods During longitudinal case studies of 6 local health trainer services, we conducted in-depth interviews with key stakeholders and analyzed service activity data. Findings Rather than an unproblematic and stable implementation of community-focused services according to the vision in Choosing Health, we observed substantial shifts in the case studies' configuration and delivery as the services embedded themselves in the local NHS systems. To explain these observations, we drew on a recently proposed conceptual framework to examine and understand the adoption and diffusion of innovations in health care systems. Conclusions The health trainer services have become more 'medicalized' over time, and in doing so, the original theory underpinning the program has been threatened. The paradox is that policymakers and practitioners recognize the need to have a different service model for traditional NHS services if they want hard-to-reach populations to engage in preventive actions as a first step to redress health inequalities. The long-term sustainability of any new service model, however, depends on its aligning with the established medical system's (ie, the NHS's) characteristics. [ABSTRACT FROM AUTHOR]

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

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

Background As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. Methods A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. Results Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). Conclusions The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation. [ABSTRACT FROM PUBLISHER]

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

The evolution of the policing role over the last decade has led to 33 police forces in England and Wales integrating restorative justice practices, in one form or another, into their responses to minor crime committed for the first time by both youths and adults. Most recently, this reform dynamic has been used in response to more serious offences committed by persistent offenders and expanded to include all stages of the criminal justice process. Despite the significant positive rhetoric that surrounds the adoption and use of restorative justice, there are a number of procedural and cultural challenges that pose a threat to the extent to which restorative justice may become embedded within the policing response. This article explores these developments and highlights where potential problems for implementation may arise as well as some strategies to overcome them. [ABSTRACT FROM PUBLISHER]

The recommendations from the Bercow Review of services for children with speech, language and communication needs (DCSF, 2008a) have significant implications for the training of pre-service teachers who will be expected to be more able to meet the needs of such children. This article explores the potential within the Standards for Qualified Teacher Status, the key framework for the development of pre-service teachers in England, to support the implementation of the Bercow Report. The discussion focuses on three recommendations: that language is central, a human right; the need for early identification and intervention; and the development of a continuum of services around the family. The article reflects on a successful and an unsuccessful implementation of policy within pre-service teacher training to better illustrate the issues entailed in realizing Bercow Review recommendations within pre-service teacher education. [ABSTRACT FROM AUTHOR]

ABSTRACT Local Safeguarding Children Boards (LSCBs) were established under the Children Act 2004 and have responsibility for coordinating and ensuring the effectiveness of the work of partner bodies to safeguard and promote the welfare of children. Drawing on data from a Department for Children, Schools and Families and Department of Health-funded evaluation, the paper examines the development of LSCBs and the challenges and issues that have been encountered by Boards in implementing new arrangements. In doing so, the paper contributes to current debates about some of the limitations of New Labour's safeguarding reforms as a vehicle for improving outcomes for children and families. [ABSTRACT FROM AUTHOR]

Background: The publication of Best research for best health in 2006 and the "ring-fencing" of health research funding in England marked the start of a period of change for health research governance and the structure of research funding in England. One response to bridging the 'second translational gap' between research knowledge and clinical practice was the establishment of nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). The goal of this paper is to assess how national-level understanding of the aims and objectives of the CLAHRCs translated into local implementation and practice in North West London. Methods: This study uses a variation of Goffman's frame analysis to trace the development of the initial national CLAHRC policy to its implementation at three levels. Data collection and analysis were qualitative through interviews, document analysis and embedded research. Results: Analysis at the macro (national policy), meso (national programme) and micro (North West London) levels shows a significant common understanding of the aims and objectives of the policy and programme. Local level implementation in North West London was also consistent with these. Conclusions: The macro-meso-micro frame analysis is a useful way of studying the transition of a policy from high-level idea to programme in action. It could be used to identify differences at a local (micro) level in the implementation of multi-site programmes that would help understand differences in programme effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this trial is to evaluate the effectiveness of providing additional support in modifying lifestyles and in reducing population cardiovascular disease risk compared with usual primary prevention care. A prospective, individually randomised controlled trial design is used, within which groups of patients are clustered by general practice. Multi-level modelling is proposed to account for clustering effects by practice and a two-stage least squares regression approach to account for expected contamination at the analysis stage. The research is set in Stoke-on-Trent, a mid-sized urban city in central England with a generally poor health profile. Patients included will be those aged between 35 and 74years who have been identified as being at increased risk of developing cardiovascular disease. Approximately 920 patients will be recruited in each arm of the trial (20 control, 20 treatment in each of 46 practices). Usual primary prevention care (control) will be compared with usual primary prevention care plus bespoke lifestyle support (treatment). The primary outcome measure is the Framingham 10-year cardiovascular disease risk at one year. Intermediate outcomes: weight, physical activity and health-related quality of life, will be determined at six months to monitor progress with treatment. Change in individual risk factors: blood pressure, lipid profile, weight, body mass index, waist circumference, smoking, diabetes and cardiovascular disease status and medications will also be measured at one year to help understand the specific mechanisms by which the primary endpoint was achieved. [Copyright &y& Elsevier]

Strategic policy has to be implemented within complex operating environments where organisations have to perform within an inter-dependent production process in a dynamic mix of competition and cooperation. This suggests that network structures need to be in place that allow for both collaboration and competition whilst mitigating against structural fragmentation. The aim of this research was to further the understanding of control and communication mechanisms and collaboration in policy implementation networks and focus upon problems of structural fragmentation in these complex policy environments. This research used a systems approach to develop a methodological framework based on Beer’s Viable System Model, work by Espejo and Social Network Analysis. The research was set in a tourism ‘cluster’ in an English seaside context, which is that part of the Yorkshire coast covered by the Scarborough Borough Council local authority, where a more culturally focussed tourism product was being introduced. [ABSTRACT FROM AUTHOR]

The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilized a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed. [ABSTRACT FROM AUTHOR]

This paper describes the development of a multi-agency model for adult protection training in Kent and Medway and sets this in the context of the evolution of wider adult protection policy and competence. The rationale for the planning and development of the model is outlined and the content and coverage of the different levels of training are described. Key issues include the progression of staff and managers and the implementation and operation of the model. These are explored in relation to the different demands on the safeguarding activities in Kent and Medway and the different agency and professional interests at stake. Future developments are also briefly mapped and discussed. [ABSTRACT FROM AUTHOR]

The article demonstrates the degree of disconnection between the overall strategic visions behind Connexions in England. It explores the reasons for the failure of the agency in implementing youth-oriented services. It highlights a ranges of problems in service implementation from initial contact and assessment through to final interventions. It is emphasized that the problems were discovered in the political, bureaucratic, financial and social contexts in which the service existed.

The Nitrates Directive (91/676/EEC) was adopted to address the issue of water pollution caused by nitrate derived from agricultural practices across the European Union (EU). This study evaluates the implementation of the Nitrates Directive by considering the perspectives of respondents from significant actor groups involved in the policy implementation process in Denmark and England. Structured field interviews were conducted and discovered that Nitrate Vulnerable Zone (NVZ) designation in England was a lengthy and inefficient process compared with that in Denmark. Generally, respondents from both countries considered that whole country designation was a more effective policy instrument than designation of discrete zones. Denmark's Action Programme measures reflected the severity of its water quality problems and go beyond the demands of the Nitrates Directive. The respondents recognized that Denmark's strict measures have led to a reduction in nitrate leaching and a decline in nitrate concentrations in streams from cultivated catchments. England's current Action Programme measures do not demand any substantial changes to farming practice and so have limited potential to reduce nitrate losses. This study concludes that a number of vague and ill prepared guidelines within the Nitrates Directive undermine its ability to protect water quality adequately, and hence current implementation of the Water Framework Directive (WFD) is an opportunity to re-shape water policy in relation to nitrate. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

This article reports an analysis of practitioner and policy implementers' views on implementing the strategy document Valuing People. It is based on empirical data generated from the first phase of a research project that seeks to develop best practice in supporting people with an intellectual disability and dementia. The analysis focuses on how Valuing People's four key principles (choice, independence, rights and inclusion) were drawn on and talked about spontaneously by participants. Each of these four principles has important implications for the provision of services for people with intellectual disabilities and dementia. This article adds to the growing dialogue on service provision for this group. [ABSTRACT FROM AUTHOR]

The Single Assessment Process (SAP) has been introduced as part of the National Service Framework for Older People and has major implications for health and social care. The aim of this study was to evaluate a pilot introduction of the Single Assessment Process in the South-East of England. A qualitative case study design incorporating observation and semi-structured interviews were used to collect data. Assessment visits were observed and recorded, and interviews were carried out with older people and their carers ( n = 9), health and social care practitioners, operational managers, and other key individuals involved in the pilot ( n = 26). Overall the evaluation found three major themes that had an impact on the implementation of the Single Assessment Process. These were: the process of implementing policy and change, the health and social care boundary, and communication and sharing of assessments. Front-line practitioners (street-level bureaucrats) had a major impact on the SAP implementation, particularly through their reluctance to engage with the process, work together and share assessments. Success of the national SAP implementation will depend on the extent to which those working directly with older people can be engaged in the policy process. [ABSTRACT FROM AUTHOR]

The Laming Report into the death of Victoria Climbie reiterated the long-standing critique of inadequate communication and coordination amongst the key professions and agencies. It led directly to the Green Paper, Every Child Matters in 2003 and the subsequent Children Act 2004. Amongst other things the Act proposes the establishment of a database on every child, which would be accessible to a range of practitioners – a measure that has been hotly contested. This article examines the reasons for this contestation and explores the extent to which a compromise might be judged to have dislodged a key policy objective. [ABSTRACT FROM AUTHOR]

Public sector reform will be at the heart of Labour's third term of office. The changes under way or planned in children's services and adult social care services in England are prototypes of the pursuit of services that are person-centred, seamless and proactive, with a focus on positive outcomes and well-being. This article examines the similarities in approach between the two sets of changes, and warns that implementation will be a difficult task. [ABSTRACT FROM AUTHOR]

Long-term conditions is a policy area that has risen rapidly up the political agenda in England, culminating in the development of the National Health Service and Social Care Model in 2005, which is to be implemented over the following 2 years. The Model draws heavily upon US ideas of case management and proposes the creation of 3000 community matrons to undertake this role with the most vulnerable patients. Although welcomed in principle, the specific proposals in the Model have been subject to some criticism, and these issues are explored in the present paper. The problematic areas include patient identification, the transplanting of US models to England, the role of case management, workforce and funding issues, and the mix of medical and social models. The author concludes that there is a danger of long-term care policy developing an unduly health-focused approach at a time when the thrust of partnership working is towards an inclusive, whole-system model. [ABSTRACT FROM AUTHOR]

Abstract The contemporary relationship between theory and practice in interprofessional learning and development is explored in the context of the United Kingdom (UK) government's multiple reform policies for ‘modernizing’ health and social care. As part of a 1-year action research programme, four local case studies in London are described. These illustrate the new collaborations being created and point to the importance of understanding, as a priority for future research and organizational developments in primary care, the changing and complex roles of non-statutory stakeholder agencies and process facilitation. Both are emerging as critical factors for effective policy implementation. Overall, the London-wide programme indicates the dysfunctional nature of excessively linear conceptual models, and the need, in practice, to espouse eclectic and dynamic approaches to theories for learning in health and social care. [ABSTRACT FROM AUTHOR]

Improvements in the rights and opportunities for people with a learning disability and/or autism (henceforth described as 'people') have led many countries to move away from long-term institutional care to community based models. However, people with behaviour that challenges and/or severe mental health problems often continue to lack the integrated support they need to make choices about how they live, resulting in poor outcomes and severe health inequalities. In 2015, following successive scandals relating to abuse and poor quality of care, the NHS in England initiated the Building the Right Support national plan, which sets out an integrated service model to reduce dependence on hospital care. Local partnerships were established to oversee integrated working between health and social care commissioners, and specialist and community providers of care, support and housing, so that people could be supported closer to home. To understand the implementation process a national, three year evaluation was commissioned by NHS England to identify good practice, and understand the success factors and barriers that lie behind consistent implementation of the service model. The evaluation has used a longitudinal mixed methodology. Data sources include repeated in-depth interviews with national and regional policymakers (n=66), a survey of practitioners, people and family members (n=232), and detailed case studies of implementation in ten localities. The evaluation has directly engaged people with lived experience and their families through workshops and focus groups and has also sought perspectives from local and national representative groups and forums. We found that despite common endorsement of the integrated service model: There are continued gaps in care and support: receiving integrated care was not a common experience of most people and their families. Autistic people with mental health conditions, and children, are particularly poorly served. Many more people than expected remain dependent on hospital care. Implementation difficulties arose in areas that did not have a shared understanding of what was required to introduce the service model and a willingness to collaborate differently to achieve it. Conversely, local areas that had inherited and/or sought to develop a shared culture and trustbased relationships between commissioners and providers (as opposed to transactional ones) were most successful. Good quality co-design is critical to implementation, so that the priorities of local services match the needs of people and their families. The time and effort required for this was not usually prioritised, despite national and local commitments to do so. Progress in implementing the model after the end of the formal programme period in March 2019 is at risk due to constrained budgets (especially in social care), recruitment and retention difficulties within the care workforce, and a loss of momentum, should the policy focus change. Therefore, while the service model is based on a widely supported model of integration, the blend of incentives, guidance, resources and compulsion has not led to consistent implementation. Honest appraisal of the scale of cultural and societal change required was somewhat overlooked, especially regarding ways that national and local bodies could work together to fund, manage and evaluate care. [ABSTRACT FROM AUTHOR]

Background: NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40-74. Uptake remains a challenge and invitation method is a strong predictor of uptake. There is evidence of low uptake when using invitation letters. Telephone invitations might increase uptake, but are not widely used. We explored the potential to improve uptake through personalising letters to patient's CVD risk, and to compare this with generic letters and telephone invitations.Methods: HEalth Check TRial (HECTR) was a three-arm randomised controlled trial in nine general practices in Staffordshire (UK). Eligible patients were randomised to be invited to a NHS Health Check using one of three methods: standard letter (control); telephone invitation; letter personalised to the patient's CVD risk. The primary outcome was attendance/non-attendance. Data were collected on a range of patient- and practice-level factors (e.g., patient socio-demographics, CVD risk, practice size, Health Checks outside usual working hours). Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance. Invitation costs were collated from practices to estimate cost benefit.Results: In total, 4614 patients were included in analysis (mean age 50.2 ± 8.0 yr.; 52.4% female). Compared with patients invited by standard letter (30.9%), uptake was significantly higher in those invited by telephone (47.6%, P < .001), but not personalised letter (31.3%, p = .812). In multi-level analysis, compared with the standard letter arm, likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm. The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk. We estimated per 1000 patients invited, risk-personalised letters could result in 40 additional attended Health Checks (at no extra cost) and telephone invitations could result in 180 additional Health Checks at an additional cost of £240.Conclusions: Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake, and could be targeted at younger and lower CVD risk adults. Risk-personalised letters should be explored further in a larger sample of high risk individuals.Trial Registration: Registration number: ISRCTN15840751 date of registration: 24/10/2017. [ABSTRACT FROM AUTHOR]

Background: In the UK just over a fifth of all children start school overweight or obese and overweight 2-5 year olds are at least 4 times more likely to become overweight adults. This can lead to serious future health problems. The WHO have recently highlighted the preschool years as a critical time for obesity prevention, and have recommended preschools as an ideal setting for intervention. However, existing evidence suggests that the preschool environment, including the knowledge, beliefs and practices of preschool staff and parents of young children attending nurseries can be a barrier to the successful implementation of healthy eating interventions in this setting.Methods: This study examined the perceptions of preschool centre staff and parents' of preschool children of healthy eating promotion within preschool settings. The participants were preschool staff working in private and local authority preschool centres in the North East of England, and parents of preschool children aged 3-4 years. Preschool staff participated in semi-structured interviews (n = 16 female, 1 male). Parents completed a mapping activity interview (n = 14 mothers, 1 father). Thematic analysis was applied to interpret the findings.Results: Complex communication issues surrounding preschool centre dietary 'rules' were apparent. The staff were keen to promote healthy eating to families and felt that parents needed 'education' and 'help'. The staff emphasised that school policies prohibited providing children with sugary or fatty snacks such as crisps, cakes, sweets and 'fizzy' drinks, however, some preschool centres appeared to have difficulty enforcing such guidelines. Parents were open to the idea of healthy eating promotion in preschool settings but were wary of being 'told what to do' and being thought of as 'bad parents'.Conclusions: There is a need to further explore nursery staff members' personal perceptions of health and how food policies which promote healthier food in preschool settings can be embedded and implemented. Family friendly healthy eating strategies and activities which utilise nudge theory should be developed and delivered in a manner that is sensitive to parents' concerns. Preschool settings may offer an opportunity for delivery of such activities. [ABSTRACT FROM AUTHOR]