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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]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

Across the four UK jurisdictions, there are distinct disparities in exclusion rates of school students. Northern Ireland, alongside Scotland and Wales, has demonstrated over time, lower rates of permanent exclusions and temporary exclusions compared with England. This paper examines these disparities from the perspectives of representatives from various system-level educational bodies and third sector organisations representing children and families who experienced the exclusion process. The paper will also present policy and legal frameworks associated with exclusion in Northern Ireland. We interviewed 9 stakeholders, associated with practices of school exclusion in Northern Ireland, from a range of system-level education bodies and advocacy groups. Findings include positive strategies perceived to keep exclusion levels low, types of obstacles or resistance to anti-exclusion policy, participants' perspectives on unofficial exclusion practice, and perspectives on official exclusion data. What emerges from interviews is a series of tensions between implementing a child-centred approach and diminishing support services and resources. We conclude that those working within the Northern Ireland education system, are committed to an inclusive approach. However, the development and implementation of effective supporting frameworks take time and consultation, and there is evidence of tension between the perceptions of those working at a system-level and those working in schools. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings: Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications: Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value: This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline relevant policies on the integration of health and social care (HSC) in the four home nations: Scotland, Wales, Northern Ireland and England and offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy.Design/methodology/approach The paper is written as a piece of critical reflection by drawing on the authors’ knowledge and expertise and wider evidence where available.Findings Since 2010, HSC integration has started to diverge significantly in the four constituent countries of the UK. Although England and Wales have undergone considerable re-organisation of the NHS, Scotland and Northern Ireland have largely been marked by organisational continuity. However, beyond organisational differences, policy approaches, policy emphases and implementation strategies have also started to show considerable dissimilarity across the UK. An important contributory factor may be different ideological perspectives on the role of competition and pilots, partnership, patient choice and organisational incentives to bring about change in the field.Research limitations/implications The paper identifies a serious lack of comparative research in integration policy, despite the considerable opportunities for quasi-experimental studies. This lack of empirical research impedes shared learning across the home nations.Originality/value The paper presents a descriptive comparison of current integration policy between HSC providers in the four home nations. It reveals considerable opportunities for further research and comparative modelling of integration approaches. [ABSTRACT FROM AUTHOR]

The research goals were to obtain an understanding of who the users of e‐books in the NHS are, what they are using e‐books for, and when and how they use them. This article presents the methodology used and the findings from the research. It also explores the outputs and next steps from the research, both for the individual countries and collectively. The Five Nations group, (library leads in England, Northern Ireland, Ireland, Scotland and Wales) commissioned research into healthcare staff use and non‐use of e‐books to understand the behaviours, needs and expectations of healthcare staff and to identify shared challenges around e‐books to inform policy and practice. [ABSTRACT FROM AUTHOR]

The debate about the financing of devolved government in Scotland, Wales and Northern Ireland has acquired a new vigour since 2007, with commissions and reviews taking place in Scotland, Wales and at Westminster. Although of considerable constitutional as well as political importance, the technical detail has obscured many of the wider issues involved. This paper surveys the options now open to the UK government, as it prepares its response to the Welsh Holtham Commission, a bill implementing the Calman Commission's recommendations for Scotland, and looks at ways of altering corporation tax in Northern Ireland. It examines six options that in principle are open to the UK government, and argues that the range of options open to the UK government are narrower than they often appear, and that pressure for it to act is such that it will no longer be possible to avoid far-reaching action. [ABSTRACT FROM AUTHOR]

Since the 1970s, there has been growing academic interest in children and young people living in state care and, more recently, in the lives of disabled children. However, there has been little attention on the lives of disabled children who are looked after by the state. This paper compares and critiques what is known about the numbers of disabled children who are looked after in England, Northern Ireland, Scotland and Wales. We discuss the conceptual and methodological limitations of systematically collecting data on disabled children in state care across the UK. We argue that to ensure that the rights of disabled children in state care are identified, acknowledged and upheld, ‘being counted’ is a fundamental first step. [ABSTRACT FROM AUTHOR]

ABSTRACT Until recently, little was known about kinship care in the UK. Research has begun to illuminate the circumstances which lead to children being cared for by relatives, and the stresses and strains experienced by carers. However, most UK research has only considered 'looked-after' children placed with formal approved kinship foster carers, although this group forms the smallest proportion of children in kinship arrangements. In this paper, we use microdata from the 2001 UK Population Census to examine the characteristics of kinship carers and children, and demonstrate that most children in kinship care are growing up in informal unregulated arrangements. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Background Secondhand smoke (SHS) exposure is higher among lower socioeconomic status (SES) children. Legislation restricting smoking in public places has been associated with reduced childhood SHS exposure and increased smoke-free homes. This paper examines socioeconomic patterning in these changes. Methods Repeated cross-sectional survey of 10 867 schoolchildren in 304 primary schools in Scotland, Wales and Northern Ireland. Children provided saliva for cotinine assay, completing questionnaires before and 12 months after legislation. Results SHS exposure was highest, and private smoking restrictions least frequently reported, among lower SES children. Proportions of saliva samples containing <0.1 ng/ml (i.e. undetectable) cotinine increased from 31.0 to 41.0%. Although across the whole SES spectrum, there was no evidence of displacement of smoking into the home or increased SHS exposure, socioeconomic inequality in the likelihood of samples containing detectable levels of cotinine increased. Among children from the poorest families, 96.9% of post-legislation samples contained detectable cotinine, compared with 38.2% among the most affluent. Socioeconomic gradients at higher exposure levels remained unchanged. Among children from the poorest families, one in three samples contained >3 ng/ml cotinine. Smoking restrictions in homes and cars increased, although socioeconomic patterning remained. Conclusions Urgent action is needed to reduce inequalities in SHS exposure. Such action should include emphasis on reducing smoking in cars and homes. [ABSTRACT FROM AUTHOR]

SummaryIntroduction1Definitions of ethnic groups and demographics of minority ethnic groups in the UK○ 1.1 Definitions of 'ethnic groups' and 'ethnicity'○ 1.2 Demographics and characteristics of minority ethnic groups in the UK– Countries of origin– Age/sex distribution and life expectancy– Geographical distribution and size of household– Religious beliefs– Education and employment patternsKey points2Overview of the health profile and dietary habits of minority ethnic groups in the UK○ 2.1 Available surveys○ 2.2 Overview of the health profiles among adults from minority ethnic groups– Overall health– Cardiovascular disease (CVD)– Coronary heart disease (CHD)– Stroke– Type 2 diabetes– Obesity○ 2.3 Possible causes of increased disease risk among minority ethnic groups○ 2.4 Smoking, drinking and physical activity habits○ 2.5 Dietary habits and nutritional status○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups– Overall health– Diet and health behaviour patterns○ 2.7 Gaps in data availabilityKey points3Factors affecting food choice– Income and socio‐economic status– Food availability and access– Awareness of healthy eating– Religious beliefs– Food beliefs– Time and cooking skills– Generation and genderKey points4Traditional diets of minority ethnic groups○ 4.1 Overview of traditional diets of minority ethic groups– South Asians– African‐Caribbeans– Chinese○ 4.2 Dietary acculturation○ 4.3 Nutritional composition of ethnic‐style cuisineKey points5Nutritional interventions and health promotion among minority ethnic groups○ 5.1 Effective nutritional interventions○ 5.2 Health promotion interventions to prevent problems associated with fasting○ 5.3 Priorities for nutritional interventions and health promotion○ 5.4 Using behaviour change models○ 5.5 Current community initiatives○ 5.6 Catering for institutionalised individuals○ 5.7 Recommendations for future research, policy and practiceKey points6Conclusion• Acknowledgements• References Summary: According to the latest census, non‐white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African‐Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well‐designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non‐white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups. [ABSTRACT FROM AUTHOR]

This paper presents the preliminary descriptive findings from an online survey commissioned by the Royal College of Nursing to ascertain members' perceptions of spirituality and spiritual care. There is a professional requirement for nurses to achieve competence in the delivery of spiritual care and to assess and meet the spiritual needs of their patients. Recently, the area of spirituality has come under criticism bringing into question the role of the nurse with regard to the provision of spiritual care. A descriptive online survey was conducted with all Royal College of Nursing members to obtain their perceptions of spirituality and spiritual care in an attempt to identify what action they feel is required with regard to this aspect of nursing practice. An online survey consisting of a five-part questionnaire was developed incorporating the Spirituality and Spiritual Care Rating Scale. Members were asked to complete the survey during a three-week period in March 2010. Overall, 4054 Royal College of Nursing members responded, making this probably the largest UK survey ascertaining nurses' perceptions of spirituality and spiritual care. Descriptive statistics, frequencies and percentages were used to identify key findings. A Cronbach's alpha of 0·80 was obtained for the Spirituality and Spiritual Care Rating Scale. The preliminary analysis confirms that nurses across the full health economy in the United Kingdom consider spirituality to be a fundamental aspect of nursing. The findings indicate that nurses recognise that attending to the spiritual needs of patients enhances the overall quality of nursing care. However, despite all the attention given to the spiritual dimension, the majority of nurses still feel that they require more guidance and support from governing bodies to enable them to support and effectively meet their patients' spiritual needs. [ABSTRACT FROM AUTHOR]

Using data on the patent portfolios of UK universities, the paper compares the levels of patenting activity (filings), success (grants) and quality (patents with commercial co-assignees and patent citations) at Welsh, Scottish and Northern Irish institutions. Patent activity, per researcher, in Wales is on a par with that in Scotland and about twice the rate in Northern Ireland, but the numbers of researchers relative to population in Wales and Northern Ireland are around half of the number in Scotland. Patent quality indicators are less favourable to Wales, while both activity levels and conversion of applications into grants are poor in Northern Ireland. It is suggested that greater cross-university collaboration in Wales and Northern Ireland would help improve performance. [ABSTRACT FROM AUTHOR]

Purpose: As the landscape in ophthalmology and related commissioning continues to change, there is a pressing need to re‐evaluate the current scope of practice of hospital optometrists working within secondary care in the UK. We aim to establish if the skills or services delivered by optometrists have changed to meet varying demands, and to better understand what changes in practice may have arisen as a result of COVID‐19. Method: A survey developed from that used in 2015 was disseminated to 129 optometry Hospital Eye Service (HES) leads in September 2020, including questions on department workforce; core services; extended roles; procedures undertaken within extended roles; level of autonomy; arrangements for prescribing; training and accreditation, and service changes in response to COVID‐19. Results: Ninety responses were received (70% response rate) from within England (76%), Scotland (22%) and Northern Ireland (2%). Whole time equivalents within units ranged from 0.4–79.2 (median of 2.5). In comparison to the 2015 survey, there was an increase in the proportion of units delivering extended roles, with glaucoma (88%) remaining the most common extended role, and new areas of practice in uveitis (21%) and vitreoretinal (13%) services. There was increased use of independent prescribing (67%) in comparison to 18% in 2015 and there was an increase in optometrists delivering laser interventions. In response to COVID‐19, optometrists were increasingly delivering telephone consultations and there were new collaborations between primary and secondary care. Conclusions: Optometrists' scope of practice continues to develop in the HES with an increased variety of roles and an apparent increase in the number of units employing optometrists, often working in roles historically performed by medical practitioners. Such changes appear necessary in recovery and transformation within ophthalmology, alongside wider optometry changes arising at the interface of primary and secondary care. [ABSTRACT FROM AUTHOR]

Brexit aimed to restore sovereignty to the United Kingdom. That rested on an interpretation of the UK as an internally integrated and externally bordered sovereign state. Another interpretation is that the UK is a plurinational union, in which the issue of sovereignty is contested. Devolution in 1999 left this issue in abeyance, while membership of the EU provided an external support system. Brexit removed this external support and resulting territorial tensions are exacerbated by the fact that majorities in Scotland and Northern Ireland opposed it. There have been three responses: to reconstitute the United Kingdom as a unitary state; to fragment it into its constituent parts; and to seek a differentiated Brexit. Only Northern Ireland has been granted such an exception, at the insistence of another Member State. [ABSTRACT FROM AUTHOR]

This article contends that the study of the history of devolution in the UK and the contemporary academic debate over devolution and the future of the UK should involve greater consideration of Northern Ireland. Specifically, it is suggested that the search for linkages, both in historical and contemporary contexts, between Scotland and Northern Ireland around the theme of devolution and constitutional change contributes significantly to an understanding of the broader issue of the interrelations between the 'Four Nations' of these islands. It is demonstrated that the Northern Ireland example of devolution influenced debate in Scotland in the post Second World War years more than has been appreciated hitherto; and that there is much to be studied in the way both places relate to each other and to the devolution debate today. [ABSTRACT FROM AUTHOR]

Following devolution, local council taxation became in whole, or in part, a devolved matter and consequently separate reviews and analysis have been undertaken for England, Scotland, Wales and Northern Ireland. This article compares the recommendations and decisions made in all four countries, following recent reviews. It explains how Northern Ireland emerged with the greatest divergence in local taxation policy. It examines the reasons for the difference from Great Britain following a rating review process, including the tradition of regional and local rates, the attempt to tackle regressivity in local taxation and the significance of criticism of banded council tax. The article also considers the relevance of devolution and other political factors in determining the policy outcomes in each country. [ABSTRACT FROM AUTHOR]

This article provides a comparative review of the interpretation and implementation of clinical governance frameworks within the four home countries of the UK - England, Northern Ireland, Scotland and Wales. Clinical governance has become one of most significant and important concepts in modern health care. The article considers the policy background and the many definitions of clinical governance, but specifically compares the various strategic and operational approaches to delivery of clinical governance in different parts of the UK. It is suggested that these variations in approach, by each of the four UK countries, can lead to confusion for healthcare professionals in trying to understand, implement and monitor elements of clinical governance in practice. [ABSTRACT FROM AUTHOR]

Spheroidal carbonaceous fly-ash particles (SCPs) are produced by the high temperature combustion of fossil-fuels such as coal and oil. They are not produced by any natural processes and therefore are unambiguous indicators of atmospheric deposition from power generation and other industrial sources. In lake sediments, SCP concentration profiles are robust, replicable and often regionally characteristic such that the main profile features can be used for sediment dating. Previous work in the UK provided dates for the three main SCP profile features for Scotland, North Wales and Northern Ireland and also highlighted the lack of information for the rest of the UK. In this study, archived SCP data and new SCP concentration profiles were compiled from 80 radionuclide-dated sediment cores from across the whole of the UK in order to determine the regional coherence of temporal trends. Using SCP cumulative percentage profiles, with the SCP concentration peak set as 100%, dates for each 10% were produced for each core. Comparing these dates, eight distinct regions were found within the UK and dated cumulative profiles, with errors, were determined for each. Despite this regionality, the whole of the UK showed the same date for the start of the record (1850±25 years) and for the 40- and 50% (1940±15 and 1955±15, respectively). The national coherence of the former is thought to be due to the large confidence limits in the radionuclide dates for this period, whilst the latter is thought to be due to the impact from the major increase in electricity demand following the Second World War and the widespread introduction and use of cheap fuel-oil. Since the 1960s the trend has been one of increasing regionalisation resulting from the introduction of particle arrestor technology, the decline of heavy industry, the move to fewer and larger sources, particularly power stations, and an increase in accuracy for the dates of recent horizons. Regional trends are seen to compare well with industrial development in the UK and in some western areas influenced by emissions from Ireland. Areas of uncertainty remain in South Wales and the northern isles. A cumulative percentile was also calculated for each region for 1963 in order that this can be compared with the 241Am and 137Cs peaks. [ABSTRACT FROM AUTHOR]

Background: Access to high-quality palliative care is inadequate for most people living and dying with serious illness. Policies aimed at optimising delivery of palliative and end of life care are an important mechanism to improve quality of care for the dying. The extent to which palliative care is included in national health policies is unknown. We aimed to identify priorities and opportunities for palliative and end of life care in national health policies in the UK. Methods: Documentary analysis consisting of 1) summative content analysis to describe the extent to which palliative and end of life care is referred to and/or prioritised in national health and social care policies, and 2) thematic analysis to explore health policy priorities that are opportunities to widen access to palliative and end of life care for people with serious illness. Relevant national policy documents were identified through web searches of key government and other organisations, and through expert consultation. Documents included were UK-wide or devolved (i.e. England, Scotland, Northern Ireland, Wales), health and social care government strategies published from 2010 onwards. Results: Fifteen policy documents were included in the final analysis. Twelve referred to palliative or end of life care, but details about what should improve, or mechanisms to achieve this, were sparse. Policy priorities that are opportunities to widen palliative and end of life care access comprised three inter-related themes: (1) integrated care – conceptualised as reorganisation of services as a way to enable improvement; (2) personalised care – conceptualised as allowing people to shape and manage their own care; and (3) support for unpaid carers – conceptualised as enabling unpaid carers to live a more independent lifestyle and balance caring with their own needs. Conclusions: Although information on palliative and end of life care in UK health and social care policies was sparse, improving palliative care may provide an evidence-based approach to achieve the stated policy priorities of integrated care, personalised care, and support for unpaid carers. Aligning existing evidence of the benefits of palliative care with the three priorities identified may be an effective mechanism to both strengthen policy and improve care for people who are dying. [ABSTRACT FROM AUTHOR]

The political settlement in Northern Ireland in 1998 included provision for the establishment of a Human Rights Commission in Northern Ireland and in Ireland, the latest in a growing number of such institutions world wide. This article describes the functions of the Northern Ireland body, its relationship with an Equality Commission to be established under the same Act, and its political context. It then explains the debate on whether there should be an equivalent Human Rights Commission for Scotland, England and Wales, a debate taking place in the context of the Human Rights Act 1998 which incorporates the ECHR into UK law. It suggests how UK human rights commissions could differ from those in the rest of the world but shows why there is nevertheless much that the UK could learn from their experience. [ABSTRACT FROM AUTHOR]

This article addresses how business and political journalists have covered transnational tax policy, an under-researched area. It analyses coverage of corporate taxation specifically where the power to decide on tax levels is devolved within a multinational state. The work considers how the UK press treated the plans to devolve and reduce corporation tax in Scotland and Northern Ireland, in the context of continued UK-wide reductions. A quantitative and qualitative content analysis illustrates that the sampled opinion and editorial framed around this issue was limited typically to the devolved territories' 'hybrid' editions of the English/UK titles. This was despite the broader impact of varying rates on press readers in the rest of the United Kingdom. Journalists tended to adopt an 'investor perspective'. A majority of commentary framed around corporation tax was focused on reducing the rate, while rarely considering the implications for government revenue. Nevertheless, importantly, Scottish coverage was bound up with broader political debates on independence. [ABSTRACT FROM AUTHOR]

The article presents a response to a paper by Mok et al. on the suicide rate for men and women in Wales, Scotland and England. The suicide rate in Scotland and Northern Ireland is higher than those for Wales. The paper also shows that there is a high incidence of frowning in Scotland, which is attributed to the presence of 90% standing freshwater in all of Great Britain.

This article addresses the challenge of promoting physical activity through a focus on equity and engaging physically inactive citizens through the development of inclusive strategies within parkrun UK—a free, volunteer-led, weekly mass community participation running event. We discuss how a UK-based action research design enabled collaboration with volunteer event organizers to understand participant experiences, constraints and develop localized inclusive practices. In contrast with 'expert'-driven health behaviour interventions, our research pursued a 'ground up' approach by asking what can be learnt from the successes and challenges of organizing community events, such as parkrun UK, to promote inclusion? A modified participatory action research approach was used with four parkrun sites across England, Scotland and Northern Ireland, that involved quantitative and qualitative analysis of survey data (n  = 655) that informed the process. Our analysis explored parkrunners' and volunteer organizers' perceptions relating to (i) the demographics of parkrun participation and (ii) actions for change in relation to the challenges of engaging marginalized groups (women, ethnic minorities, low income, older people, those with disabilities or illness). We discuss the challenges and opportunities for addressing (in)equity and inclusion through volunteer-based organizations and the implications for translating knowledge into organizational strategies. [ABSTRACT FROM AUTHOR]

Background: Stratifying patient populations by risk of adverse events was believed to support preventive care for those identified, but recent evidence does not support this. Emergency admission risk stratification (EARS) tools have been widely promoted in UK policy and GP contracts.Aim: To describe availability and use of EARS tools across the UK, and identify factors perceived to influence implementation.Design and Setting: Cross-sectional survey in UK.Method: Online survey of 235 organisations responsible for UK primary care: 209 clinical commissioning groups (CCGs) in England; 14 health boards in Scotland; seven health boards in Wales; and five local commissioning groups (LCGs) in Northern Ireland. Analysis results are presented using descriptive statistics for closed questions and by theme for open questions.Results: Responses were analysed from 171 (72.8%) organisations, of which 148 (86.5%) reported that risk tools were available in their areas. Organisations identified 39 different EARS tools in use. Promotion by NHS commissioners, involvement of clinical leaders, and engagement of practice managers were identified as the most important factors in encouraging use of tools by general practices. High staff workloads and information governance were identified as important barriers. Tools were most frequently used to identify individual patients, but also for service planning. Nearly 40% of areas using EARS tools reported introducing or realigning services as a result, but relatively few reported use for service evaluation.Conclusion: EARS tools are widely available across the UK, although there is variation by region. There remains a need to align policy and practice with research evidence. [ABSTRACT FROM AUTHOR]

Background Giving children the best start in life is critical for their future health and wellbeing. Political devolution in the UK provides a natural experiment to explore how public health systems contribute to children's early developmental outcomes across four countries. Method A systematic literature review and input from a stakeholder group was used to develop a public health systems framework. This framework then informed analysis of public health policy approaches to early child development. Results A total of 118 studies met the inclusion criteria. All national policies championed a 'prevention approach' to early child development. Political factors shaped divergence, with variation in national conceptualizations of child development ('preparing for life' versus 'preparing for school') and pre-school provision ('universal entitlement' or 'earned benefit'). Poverty and resourcing were identified as key system factors that influenced outcomes. Scotland and Wales have enacted distinctive legislation focusing on wider determinants. However, this is limited by the extent of devolved powers. Conclusion The systems framework clarifies policy complexity relating to early child development. The divergence of child development policies in the four countries and, particularly, the explicit recognition in Scottish and Welsh policy of wider determinants, creates scope for this topic to be a tracer area to compare UK public health systems longer term. [ABSTRACT FROM AUTHOR]

This article draws on findings from the first cross-national study of school exclusions in the four jurisdictions of the UK. It sketches factors associated with the past research with reductions in exclusions. It then reports interview data gathered in England in 2018 from five specialist officers working in two Local Authorities and a senior officer working for a national voluntary organisation. The officers describe good practice but also national, local and school level developments contributing to a deteriorating situation. These developments include unhelpful government guidance and regulations; school accountability frameworks affecting curriculum and leading to the neglect of Special Educational Needs; loss of Local Authority powers and funding resulting in reductions in support services. Data gathered for this study in other UK jurisdictions suggests that in Scotland and Northern Ireland, and to a lesser extent in Wales, a practice that avoids school exclusions has persisted more than in England. [ABSTRACT FROM AUTHOR]

The referendum vote for Remain in Scotland and Northern Ireland and the small majority for Leave in Wales immediately attracted much attention to the position of the devolved governments on Brexit negotiations and to the impact of Brexit on their jurisdictions. As the core of devolved powers relate to social policy, identifying the impact of leaving the EU on aspects of social policy is highly significant. This article examines the impact of EU programmes, funding, directives and regulations as delivered in recent years, noting the nature of the participation of the devolved administrations in EU decision making. The post-referendum concerns of the devolved governments and their approaches to Brexit and Brexit negotiations are explained. Also discussed are the likely major changes as well as possible changes that will take place in the operation of devolution after Brexit. [ABSTRACT FROM AUTHOR]

Aims To investigate the relationships between age at diagnosis of diabetes, age at diabetic eye screening and severity of diabetic retinopathy at first and subsequent screenings in children aged 12 or 13 years. Methods Data were extracted from four English screening programmes and from the Scottish, Welsh and Northern Irish programmes on all children with diabetes invited for their first and subsequent screening episodes from the age of 12 years. Retinopathy levels at first and subsequent screens, time from diagnosis of diabetes to first screening and age at diagnosis in years were calculated. Results Data were available for 2125 children with diabetes screened for the first time at age 12 or 13 years. In those diagnosed with diabetes at 2 years of age or less, the proportion with retinopathy in one or both eyes was 20% and 11%, respectively, decreasing to 8% and 2% in those diagnosed between 2 and 12 years ( P < 0.0001). Only three children (aged 8, 10 and 11 years at diagnosis of diabetes) had images graded with referable retinopathy and, of these, two had non-referable diabetic retinopathy at all subsequent screenings. Of 1703 children with subsequent images, 25 were graded with referable diabetic retinopathy over a mean follow-up of 3.1 years, an incidence rate of 4.7 (95% confidence interval, 3.1-7.0) per 1000 per year. Conclusions In this large cohort of children, the low prevalence and incidence rates of referable diabetic retinopathy suggest that screening earlier than age 12 is not necessary. [ABSTRACT FROM AUTHOR]

Northern Ireland and Scotland could and should stay within the European Union while remaining inside the United Kingdom. This proposal need not prevent, and may facilitate, England and Wales in leaving the EU, and it is in accordance with the respective preferences of the peoples of the two Unions who voted in the advisory referendum held on 23 June 2016. Prime Minister May and her Cabinet should address carefully the question of whether to trigger Article 50, or instead to give notice that only parts of the UK-England and Wales-will be leaving the EU. The price of enforcing the entirety of the UK's exit from the EU may be lasting damage to the two Unions that make up the United Kingdom of Great Britain and Northern Ireland. [ABSTRACT FROM AUTHOR]

Prostate cancer is the most common cancer in men in the UK accounting for 25% of all new cases of cancer. It is predicted to become the most common cancer overall by 2030. A national survey of the specialist nursing workforce caring for men with prostate cancer was completed across the four countries of the UK during June and July 2014. In total 302 specialist nurses completed the survey and data from 285 was used in the analysis. This is the biggest whole population survey of this workforce in recent years. The most common job title was clinical nurse specialist (185) and the most common band was agenda for change band 7 (174). However in Scotland 50% of the respondents stated that they were paid on band 6. Over half the group (158) had worked in prostate cancer care for more than 10 years. Few (48) had come into specialist posts from a specific specialist nurse development role. There is wide geographic variation in the provision of specialist nursing for men with prostate cancer. This is reflected in available hours and caseload sizes. The respondents reported frozen and vacant posts across the UK. This equated to 58·3 full time equivalents. The work of specialist nurses caring for men with prostate cancer is clinically complex and appears to cover most key times in the cancer journey. However workload appears to be limiting the care that the nurses are able to provide with over half the respondents (163) saying that they left work undone for patients. [ABSTRACT FROM AUTHOR]

Objectives The aims of this study were to determine whether UK child development teams (CDTs) have implemented good practice recommendations for the co-ordinated assessment and support of children with neurodisability and to explore some of the factors associated with variations in good practice implementation. Design Surveys were sent to every UK CDT in 2009/2010. Responses about CDT provision and ways of working were compared with good practice recommendations from national policy documents and professional organizations. The extent to which CDTs in England and Wales met 11 selected good practice recommendations was scored; teams in Scotland and Northern Ireland were given a score out of 9 to reflect the optional use of the common assessment framework and early support materials in these countries. Results Responses were received from 225/240 (94%) UK CDTs. Thirty-seven per cent of CDTs in England and Wales had implemented nine or more of the 11 recommendations. Fifty-nine per cent of teams in Scotland and 78% of teams in Northern Ireland met between six and nine recommendations of good working practice. Higher levels of implementation of recommendations were found when the CDT had a Child Development Centre base and for teams who had received increased funding in the 5 years preceding the survey. Conclusions There was considerable variability in the degree to which CDTs implemented good practice recommendations for the diagnosis and management of children with neurodisability. Evidence about child and parent satisfaction, and the effectiveness of CDT practices and provision, is required, so policymakers, healthcare commissioners and clinicians can provide the most appropriate services to children with neurodisability and their families. [ABSTRACT FROM AUTHOR]

This article considers the trajectory and effectiveness of policy, procedures and practice in the UK since the early 1990s in responding to young people who display problematic and harmful sexual behaviours. It draws on data from three publications in which research, policy and practice in the last 20 years have been reviewed. Key themes raised by Masson and Hackett are revisited including: denial and minimisation; terminology and categorisation; similarities with other young offenders; the child protection and youth justice systems; and assessment and interventions. The authors find that there is improvement in recognition of, and practice in response to, this group of young people, but good practice standards are inconsistently applied. With devolution of political powers, Scotland and Northern Ireland are now embarking on a more strategic response than England. The absence of a public debate and prioritising of primary prevention of child sexual abuse is noted. [ABSTRACT FROM PUBLISHER]

The article provides information on political issues surrounding special education in Great Britain as of June 1, 2014. Topics discussed include the use of shared education in Northern Ireland, individual development plans (IDPs) in Wales, and the passage of the Children and Young People Act in Scotland.

BackgroundAgeing is an important factor in the development of mental health problems and their treatment. We assessed age trajectories of common mental disorders (CMDs) and psychotherapy utilization from adolescence to old age, and examined whether these trajectories were modified by time period or birth cohort effects.MethodBritish Household Panel Survey (BHPS) with an 18-year follow-up between 1991 and 2009 (n = 30 224 participants, aged 15–100 years, with an average 7.3 person-observations per person). CMDs were assessed with the 12-item version of the General Health Questionnaire (GHQ). Psychotherapy treatment utilization during the past year was self-reported by the participants. The modifying influences of time period and cohort effects were assessed in a cohort-sequential longitudinal setting.ResultsFollowing a moderate decrease after age 50, the prevalence of GHQ caseness increased steeply from age 75. This increase was more marked in the 2000s (GHQ prevalence increasing from 24% to 43%) than in the 1990s (from 22% to 34%). Psychotherapy utilization decreased after age 55, with no time period or cohort effects modifying the age trajectory. These ageing patterns were replicated in within-individual longitudinal analysis.ConclusionsOld age is associated with higher risk of CMDs, and this association has become more marked during the past two decades. Ageing is also associated with an increasing discrepancy between prevalence of mental disorders and provision of treatment, as indicated by lower use of psychotherapy in older individuals. [ABSTRACT FROM PUBLISHER]

Dickens J. The definition of social work in the United Kingdom, 2000-2010. This article reviews the approaches that the four countries of the United Kingdom - England, Scotland, Wales and Northern Ireland - have taken in recent years for organising, regulating and defining social work. Social work is one of the policy areas that have been devolved to the constituent countries. This has brought extensive organisational changes, multiple policy initiatives and a proliferation of regulatory and advisory agencies. The article focuses on the attempts by these official bodies to define social work, treating the United Kingdom as a case study of the tensions of specifying what social work is and what it should be. The various attempts expose the strains and overlaps between the different agencies, and a bigger struggle to contain and control social work. The article highlights four key dimensions in the enduring debates: values-roles, social-individual, care-control and public-professional. [ABSTRACT FROM AUTHOR]

The article discusses importance of good nutrition in children. It highlights the nutrition needed by children and adolescents which are high in relation to their size due to their demands for growth. It also explores the results of the National Diet and Nutrition Surveys (NDNS) wherein data on the eating patterns of people living in private households in Great Britain is provided.

Addressing the quality of services provided in Emergency Departments (EDs) has been a central area of development for UK government policy since 1997. Amongst other aspects of this concern has been the recognition that EDs constitute a critical boundary between the community and the hospital and a key point for the identification of social care needs. Consequently, EDs have become the focus for a variety of service developments which combine the provision of acute medical and nursing assessment and care with a range of activities in which social care is a prominent feature. One approach to this has been the establishment of multidisciplinary teams aiming to prevent re-attendance or admission, re-direct patients to other services, or speed patients through EDs with the aim of providing improved quality of care. This study, carried out between September 2007 and April 2008, was the first UK national survey of social care initiatives based in EDs and aimed to determine the objectives, organisation, extent, functions, funding and evidence on outcomes of such interventions. Eighty-three per cent of UK Type I and II EDs responded to the survey. Approximately, one-third of EDs had embedded social care teams, with two-thirds relying on referrals to external social care services. These teams varied in their focus, size and composition, leadership, availability, funding and permanence. As a result, the unintended effect has been to increase inequities in access to social care services through EDs. Three further conclusions are drawn about policy led, locally-based service development. This survey adds to international evidence pointing to the potential benefits of a variety of social care interventions being based in EDs and justifies the establishment of a research programme which can provide answers to key outstanding questions. [ABSTRACT FROM AUTHOR]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

Information about several topics discussed at the meeting of European Nutrition Foundations in Madrid on April 2010 is presented. Topics of the meeting include the nutrition in the school curriculum and regulations on foods and drinks provided in schools. The meeting features various executives including Juan Ballasteros.

The article discusses the politics and policies of the British National Health System (NHS) as of September 2008. It examines the policymaking decisions of the governments of England, Northern Ireland, Scotland, and Wales. It discusses changes in government-run health systems and health care options in welfare states. The article examines the policies and proposals of British political parties including the Labour Party and the Scottish National Party (SNP). It discusses the creation of Foundation Trusts (FTs) through the NHS.

Much attention has been paid to the asymmetrical features of devolution between Scotland, Wales and Northern Ireland but the relationship of non-departmental public bodies and other quangos to the new devolved institutions presented a largely similar challenge and produced a degree of convergence in policies. This article examines why quangos and their position in the distribution of governance was a particularly salient issue in the context of devolution and led to the adoption of similar policies aimed at a rationalisation and democratisation of quangos. The article focuses on the implementation of these policies and identifies the limited outcomes, the constraints on a more comprehensive redistribution of the functions of quangos in the three countries and the possibility of achieving some of the policy objectives without radical restructuring. It also examines the difficulties in formulating principles to determine which functions are appropriate for delegation to quangos within devolved systems of government. [ABSTRACT FROM AUTHOR]

Background: Health policy in the UK has rapidly diverged since devolution in 1999. However, there is relatively little comparative data available to examine the impact of this natural experiment in the four UK countries. The Quality and Outcomes Framework of the 2004 General Medical Services Contract provides a new and potentially rich source of comparable clinical quality data through which we compare quality of primary medical care for coronary heart disease (CHD), stroke, hypertension and diabetes across the four UK countries.Methods: A cross-sectional analysis was undertaken involving 10,064 general practices in England, Scotland, Wales and Northern Ireland. The main outcome measures were prevalence rates for CHD, stroke, hypertension and diabetes. Achievement on 14 simple process, 3 complex process, 9 intermediate outcome and 5 treatment indicators for the four clinical areas.Results: Prevalence varies by up to 28% between the four UK countries, which is not reflected in resource distribution between countries, and penalises practices in the high prevalence countries (Wales and Scotland). Differences in simple process measures across countries are small. Larger differences are found for complex process, intermediate outcome and treatment measures, most notably for Wales, which has consistently lower quality of care. Scotland has generally higher quality than England and Northern Ireland is most consistently the highest quality.Conclusion: Previously identified weaknesses in Wales related to waiting times appear to reflect a more general quality problem within NHS Wales. Identifying explanations for the observed differences is limited by the lack of comparable data on practice resources and organisation. Maximising the value of cross-jurisdictional comparisons of the ongoing natural experiment of health policy divergence within the UK requires more detailed examination of resource and organisational differences. [ABSTRACT FROM AUTHOR]

Background: Within the UK, there has been debate on whether life expectancy is increasing or decreasing in particular single or 3-year periods, but there has been less thinking whether overall trends have changed. This paper considers the extent to which the trends in life expectancy for the UK and its nations have changed before and after 2011., Methods: We used the Office for National Statistics period life expectancy data for the UK and its nations. We used Lee's approach to project life expectancy based on repeated sampling of year-to-year change in the baseline periods (1990-2011 and 1980-2011) and applied that to 2012 onwards., Findings: Improvements in period life expectancy were substantially and consistently lower between 2012 and 2018 than predicted from the trends from 1980 and, especially, from 1990. By 2018, life expectancy was lower than projected for females and males, respectively, by 1.22 and 1.52 years (England), 1.44 and 0.95 years (Northern Ireland), 1.30 and 1.44 years (Scotland), 1.53 and 1.63 years (Wales) and 1.24 and 1.49 years (UK overall), based on the 1990-2011 baseline period. Using a longer baseline period, which includes the slower rates of improvement during the 1980s, slightly reduces the gap between the current life expectancies and the projected medians., Interpretation: Future academic and policy focus should be on the deviation of the life expectancy trends from the baseline projection rather than on year-to-year variation. Concerted policy focus to return life expectancy to the projected trends is now urgently required., Competing Interests: Competing interests: None., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Diabetes impairs the quality of life of people living with the condition and is a major public health concern. The aim of this paper is to create a state of the nation report of diabetes in the UK., Methods: Diabetes UK collates information about diabetes from diverse sources. This paper synthesizes these data to create a national report., Results: Some 7% of the UK population are now living with diabetes; approximately one million people have undiagnosed type 2 diabetes, 40 000 children have diabetes and more than 3000 children are diagnosed every year. Forty-nine per cent of people with type 1 diabetes were offered structured education, but only 7.6% attended; the corresponding figures for type 2 diabetes were 90% and 10.4%, respectively. Among people with diabetes, 28% reported having issues obtaining medication or equipment for self-management. Fifty-seven per cent of people with type 1 diabetes and 42% with type 2 diabetes do not receive all eight annual health checks. Around 40% of people with diabetes have diminished psychological well-being. One-third of people have a microvascular complication at the time of diagnosis of type 2 diabetes. Diabetes is responsible for 530 myocardial infarctions and 175 amputations every week. The National Health Service spends at least £10 billion a year on diabetes, equivalent to 10% of its budget; 80% is spent treating complications. One in six hospital inpatients has diabetes., Conclusion: Diabetes continues to place a significant burden on the individual with diabetes and wider UK society. This report will be updated annually to understand how diabetes is changing across the UK., (© 2020 Diabetes UK.)