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The NHS England Radiotherapy Service Specification calls for routine use of patient-reported outcome measures (PROMs). However, barriers exist at patient, healthcare professional and service levels. The aim of the present study was to determine the current use of PROMs within radiotherapy services in England. The current attitudes, barriers and enablers to the implementation of PROMs in radiotherapy practice were evaluated and practical recommendations to inform future implementation were developed. A mixed-methods approach was adopted to obtain quantitative and qualitative data. An online questionnaire was developed and disseminated to all radiotherapy operational delivery network managers across England. The questionnaire consisted of 12 open and closed questions relating to PROMs use, with the option to provide free-text responses. Inductive thematic analysis was conducted on free-text comments, whereas descriptive statistics were used to analyse quantitative data. In total, 182 responses were received from 40 of the 50 radiotherapy providers, resulting in a response rate of 84%. The current use of PROMs was analysed, including rationale for use, tools used, format of PROMs collection and timing within the radiotherapy pathway. Most respondents indicated that PROMs were used in the context of clinical trials only. Through thematic analysis, four identical key themes were identified relating to both barriers and enablers to PROMs use; these included IT infrastructure, time, human/financial resources and training/education. A fifth theme, standardisation, was identified as a key enabler to PROMs use. Our findings show that outside of clinical trials, PROMs are not routinely used in radiotherapy services due to barriers identified at professional and service levels. Here we provide recommendations to mitigate the barriers identified and implement PROMs in radiotherapy, including training for healthcare professionals and standardisation of PROMs tools and storage. This study provides a key first step in driving PROMs implementation within radiotherapy services across England. • Outside of clinical trials, PROMs were not widely used within radiotherapy services. • Common PROMs used included QOL, anxiety/depression and urinary/bowel function tools. • PROMs are completed using either paper or electronic forms, by staff or patients. • Barriers include IT infrastructure, time, resources (staff/finances) and training. • Enablers included IT, time, resources, training and standardisation. [ABSTRACT FROM AUTHOR]

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity. • The non-patient-facing work of general practitioners is often invisible or hidden. • Hidden work is associated with complexity and uncertainty. • Behind-the-scenes work is care work, just as direct work with patients is care work. • Doctors face tensions between completing tasks and working a manageable day. • Combining practice theory with the Listening Guide embraces multi-vocality. [ABSTRACT FROM AUTHOR]

Synthetic cannabinoids (i.e. Spice) are a major public health problem in UK prisons, however, research in this area is limited. Here we aimed to draw comparisons between people with and without experience of using synthetic cannabinoids in prison, to characterise the features of, and motivations for use within this setting and evaluate support for different treatment interventions. Questionnaires were administered to 122 people in a category-B prison for adult males in England between July 2022 and March 2023. Participants were asked questions related to their sociodemographic and custodial characteristics, use of synthetic cannabinoids (and other drugs) inside and outside of prison and psychological distress was measured via the Brief Symptom Inventory (BSI-18). Those that had ever used synthetic cannabinoids in prison completed additional questions related to features of use, motivations for use and support for various interventions. In total 46.7 % (n = 57) of participants reported use of synthetic cannabinoids in prison and this group experienced significantly greater levels of psychological distress compared to those reporting no use (mean (± standard deviation) BSI-18 scores = 23.7 (±16.7) vs 12.8 (±13.6), p < 0.001). Participants mostly reported using paper-based preparations (77.4 %) and use via e-cigarettes (75.9 %). The most strongly endorsed motivations for use included to alleviate boredom (91.1 % strongly agree/agree), to make the sentence pass faster (89.3 % strongly agree/agree) and to cope with stress (80.4 % strongly agree/agree). The interventions that received most support were strategies to better manage time and medication to manage withdrawal. The use of synthetic cannabinoids in UK prisons typically involves the use of paper-based preparations via e-cigarettes, and use is associated with greater levels of psychological distress. Motivations for use were mostly pragmatic (e.g. to alleviate boredom or cope with stress) and interventions should prioritise increasing the time individuals spend out of cells and in meaningful activity. [ABSTRACT FROM AUTHOR]

Background: Apparent overconfidence and underconfidence in clinicians making clinical judgements could be a feature of evaluative research designs that fail to accurately represent clinical environments. Objectives: To test the effect of improved realism of clinical judgement tasks on confidence calibration performance of nurses and student nurses. Design: A comparative confidence calibration analysis. Settings: The study was conducted in a large university of Northern England. Methods: Ninety-seven participants rated their confidence - using a scale that ranged from 0 (no confidence) to 100 (totally confident) on dichotomous clinical judgements of critical event risk. The judgements were in response to 25 paper-based and 25 higher fidelity scenarios using a computerised patient simulator and clinical equipment. Scenarios, and judgement criteria of 'correctness', were generated from real patient cases. Using a series of calibration measures (calibration, resolution and over/underconfidence), participants' confidence was calibrated against the proportion of correct judgements. The calibration measures generated by the paper-based and high fidelity clinical simulation conditions were compared. Results: Participants made significantly less accurate clinical judgements of risk in the high fidelity clinical simulations compared to the paper simulations (P = 0.0002). They were significantly less confident in high fidelity clinical simulations than paper simulations (P = 0.03). However, there was no significant difference of over/underconfidence for participants between the two simulated settings (P = 0.06). Participants were no better calibrated in the high fidelity clinical simulations than paper simulations, P = 0.85. Likewise, participants had no better ability of discriminating correct judgements from incorrect judgements as measured by the resolution statistic in high fidelity clinical simulations than paper simulations, P = 0.76. Conclusions: Improving the realism of simulated judgement tasks led to reduced confidence and judgement accuracy in participants but did not alter confidence calibration. These findings suggest that judgemental miscalibration of confidence in nurses may be a systematic cognitive bias and that simply making scenarios more realistic may not be a sufficient condition for correction. [ABSTRACT FROM AUTHOR]

• Survey respondents had their first suicidal thoughts, on average, at 13.6 years. • Forms of suicidal thoughts were passive, active and chronic suicidal ideation. • During and after leaving care, suicidal thoughts can re-occur and intensify. • English and German samples show similar occurrences of suicidal thoughts. • English participants judge their care experience to affect their attitude towards life. This paper investigates the range of suicidal ideation among people with care experience. People who grew up in care have an elevated risk of suicidal ideation, behavior and dying by suicide compared to people without care experience. However, a comprehensive and in-depth understanding of when suicidal ideation occurs and how care-experienced people experience suicidal thoughts, especially when leaving care in England and Germany, is currently not available but would help to inform suicide prevention tailored to care-experienced people across different ages. Aiming to address this gap, the current study applied a mixed-methods approach, combining an online survey and semi-structured interviews with young adults with care experience from England and Germany. The survey included 45 adults with care experience, age 18–40, and interviews were conducted with 13 care-experienced young adults from both countries. Descriptive statistical and significance tests were conducted to analyze the survey data with SPSS. Framework analysis was used to analyze the interviews. The findings show that many participants experienced suicidal thoughts from a young age and at different times up to adulthood. A range of suicidal thoughts and trajectories are identified with an increased risk of suicide for young people with care experience, especially during transitions such as when leaving care in early adulthood. The study underlines the need for a stronger recognition of suicide prevention in social work and the (leaving) care system across different countries. [ABSTRACT FROM AUTHOR]

Background The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. Aim To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. Design A mixed-methods study. Setting Nursing care homes in south-east England. Participants Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Methods Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by ‘following a thread’. This paper reports study data in relation to facilitation. Results Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: ‘fitting it in’ facilitation; ‘as requested’ facilitation; and ‘being present’ facilitation. ‘Being present’ facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a ‘being present’ approach to facilitation. Conclusions Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study ‘being present’ facilitation, when supported by multi-layered learning, was the only approach that initiated the change required. [ABSTRACT FROM AUTHOR]

Background: Family carers provide strong support for many older adults, often enabling older adults to remain at home. Little is known about the care recipients' perspectives of the role and contributions of family carers, particularly when hospital admissions occur as part of end of life care. Aim: This paper explores the meanings of family caring for care recipients by drawing on older adults' perspectives about the impact of hospital admission on established family caring relationships. Design: Exploratory semi-structured qualitative interviews. Key findings reported in this paper emerged from within the inductive research design. Setting: Interviews were conducted in older adults' place of residence in northwest England between June 2009 and July 2010. Participants: Participants were 27 older adults living with heart failure (n = 13) or lung cancer (n = 14), aged 69-89 years (mean 79 4.3 years) and considered by their health professionals to be in their last year of life. In 12 of the interviews, a family carer was also present and made contributions. Findings: For community-dwelling older adults, family carers are conceptualised as 'conductors'; making strong contributions to maintaining the rhythm of good care throughout the illness trajectory. Following older adults' hospital admission, family carers find themselves in the role of 'second fiddle', their ability to work with the individual and to make or influence decisions vastly reduced. Despite this, carers continue to invest considerable effort in maintaining continuity in the carer relationship to maximise the individual's wellbeing by identifying needs, filling gaps in provision and advocating on patients' behalf. Family carers act flexibly to provide continuity, support and take responsibility for older adults' wellbeing across settings. Conclusions: Nurses and family carers working together, and greater appreciation of the contribution and role of family carers by health professionals may contribute to improving the quality and continuity of care for older adults. [ABSTRACT FROM AUTHOR]

There is limited literature on the processes of choice-making in families of young people with learning disabilities. This paper examines the factors considered by parents of young people with learning disabilities when deciding their own and their child's role in a range of significant choices (health, social care and education) about their child's life. The paper reports data collected from a sub-sample of 14 parents recruited from 11 families participating in a longitudinal (2007–2010) qualitative study based in England. The parents all had children with learning disabilities and participated throughout the study. Data were collected over three semi-structured interviews. Parents' accounts demonstrated a continuum of parental involvement ranging from young people being unaware a choice was taking place to young people being fully involved in choice-making. Parents did not always adopt the same approach to choice-making; different approaches to their own and their son/daughter's level of involvement emerged when parents discussed different choices. Five choice-making factors are presented. These factors were used by parents to guide their own and their child's level of involvement. Although young people's level of understanding was considered, it was not always the most important factor. Other factors were important and, at times, could be considered more important by parents. The other factors were: parents' views on the nature of the choice, protecting their child, parents' personal attitudes/beliefs and confidence in practitioner knowledge. Insights from these factors highlight some important practice issues when practitioners work with families of young people with learning disabilities making significant life-choices. [Copyright &y& Elsevier]

Background Venous leg ulcer management in the UK varies significantly. Judgements made by nurses contribute to this variability and it is often assumed that specialist nurses make better judgements than non-specialist nurses. This paper compares the judgements of community tissue viability specialist nurses and community generalist nurses; specifically, the ways they use clinical information and their levels of accuracy. Objectives To compare specialist and non-specialist UK community nurses’ clinical information use when managing venous leg ulceration and their levels of accuracy when making diagnoses and judging the need for treatment. Design Judgement analysis. Setting UK community and primary care nursing services. Participants 18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Methods Data were collected in 2011 and 2012. 18 community generalist nurses and 18 community tissue viability specialist nurses made diagnostic and treatment judgements on 110 clinical scenarios and indicated their confidence in each of their judgements. Scenarios were generated from real patient cases and presented online using text and photographs. An expert panel made judgements, and reached consensus on the same scenarios. These judgements were used as a standard against which to compare the participants. Logistic regression models and correlational statistics were used to generate various indices of judgement “performance”: accuracy, consistency, confidence calibration and information use. Differences between groups of nurses with different levels of characteristics linked to expertise were explored using analysis of variance. Results Specialist nurses had similar cue usage to the generalist nurses but were more accurate when making diagnostic and treatment judgements. Conclusion It is not obvious why the tissue viability specialist nurses were more accurate. One possible reason might be the greater opportunities for ‘deliberate practice’ afforded to specialists. However, restricting aspects of practice only to specialist nurses is likely to hinder the judgement performance of generalists. [ABSTRACT FROM AUTHOR]

Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) – a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) – a dataset on specialist mental health care with national coverage – for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. [ABSTRACT FROM AUTHOR]

Objectives: To examine variability across England in certification rates for age related macular degeneration (AMD) between 1st April 2011 and 31st March 2012. Study design: Cross-sectional survey. Methods: An electronic version of the CVI, the ECVI, was used at the Certifications Office, London, to transfer information from paper based certificates into a database. The electronic certifications data set was queried for all certificates completed in England between April 1st 2011 and March 31st 2012 with the main cause of certifiable visual loss being AMD or with the main cause of certifiable visual loss being multiple pathology but a contributory cause being AMD. Data were explored by type of AMD, visual status, age and sex and then directly standardized rates were computed by English region. Results: The Certifications Office received 23,616 CVIs for England between April 2011 and March 2012, of which 10,481 (44%) were people certified severely sight-impaired (blind) (SSI) and 12,689 (54%) were certified as sight-impaired (partial sight) (SI). The remainder did not have visual status classified. AMD contributed to 11546 causes of certification on the CVI forms during this period, 53% of forms being for geographic atrophy (GA)/dry AMD which is currently mostly untreatable. The median (interquartile) age at certification for AMD was 86 (81, 90) years and women were more commonly certified than men (66%). Considerable variability was seen across English regions, although there was consistency in that GA was the more common form in all areas. Conclusions: There is considerable regional variability in CVI rates in England, which are not attributable to differences in age or sex. Reasons for such variability need examination yet this should not undermine the value of these data in terms of describing those newly registered with sight impairment due to AMD who are predominantly female and over 85 years of age. [ABSTRACT FROM AUTHOR]

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders ( n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship – melding political, commercial and stakeholder insights – as a coping mechanism to health system constraints. [ABSTRACT FROM AUTHOR]

Objectives: In the UK, women aged 50-70 are offered breast cancer screening every three years. Screening participation rates in London have been particularly low. Low rates have been associated with low socio-economic status, and some ethnic groups have been observed to be underserved by cancer screening. This paper reports on a telephone reminder intervention in London Newham, an area of high deprivation and ethnic diversity. Study Design: Observational study of planned intervention. Methods: Women invited for breast screening were telephoned to confirm receipt of the invitation letter, remind invitees of their upcoming appointment, and to provide further information. Aggregate data at general practice level on invitation to and attendance at breast screening and on numbers reached by telephone were analysed by logistic regression. Results: For the 29 participating GP practices (10,928 invitees) overall uptake in 2010 was higher compared to the previous screening round in 2007 (67% vs. 51%; p < 0.001). On average 59% of invitees were reached by the reminder calls. A 10% increase in women reached resulted in an 8% increase in the odds of women attending their screening appointment (95% Cl: 5%-ll%), after adjusting for 2007 attendance rates. Practices with a higher proportion of South Asian women were associated with a larger uptake adjusted for 2007 uptake and population reached by the telephone intervention, (4% increase in odds of attendance per 10% increase in South Asian population, Cl 1%-7%, p = 0.003) while practices with a higher proportion of black women were associated with a smaller uptake similarly adjusted. (11% decrease in odds of attendance per 10% increase in black population, Cl 9%-16%, p < 0.001). Conclusions: A language- and culture-sensitive programme of reminder calls substantially improved breast cancer screening uptake. [ABSTRACT FROM AUTHOR]

Previous research shows low mortality for most immigrants compared to natives in host countries. This advantage is often attributed to health selection processes in migration and to protective health behaviours. Little research has examined the role of data quality, especially the registration of moves. Registration errors relating to moves between origin and host countries can mismatch deaths and risk populations, leading to denominator bias and an under-estimation of migrant mortality (data artefact). The paper investigates the mortality of immigrants in England and Wales from 1971 to 2001 using the Office for National Statistics Longitudinal Study (ONS LS), a 1% sample of the population of England and Wales. We apply parametric survival models to study the mortality of 450,000 individuals. We conduct sensitivity analysis to assess the impact of entry and exit uncertainty on immigrant mortality rates. The analysis shows that most international migrants have lower mortality than natives in England and Wales. Differences largely persist when we adjust models to entry and exit uncertainty and they become pronounced once we control for individual socioeconomic characteristics. This study supports low mortality among immigrants and shows that results are not a data artefact. [ABSTRACT FROM AUTHOR]

Neoliberalism, austerity and health responsibilisation are increasingly informing policies and practices designed to encourage older patients to take responsibility for the management of their own healthcare. Combined with an ageing population, novel ways to address the increasing healthcare needs of older people have become a priority, with the emergence in recent years of new models of integrated care enhanced by combinatorial health technologies (CHTs). This paper presents qualitative findings from the evaluation of one programme, the Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed, a programme funded by NHS England and conducted in England between 2016 and 2018. Drawing on data from patients, family carers, and staff members involved in the programme, this paper explores the extent to which CHTs, as part of the LCIA Test Bed programme, contributed to health responsibilisation amongst older people with complex health conditions. Through this programme, we find that relationships between patients, family carers and healthcare professionals combined to create a sense of reassurance and shared responsibility for all parties. Our findings suggest the need for a more nuanced approach to responsibilisation and self-management for older people living with complex health conditions. By focusing on co-management – and recognising the potential of CHTs to facilitate this approach – there is potential to increase patient confidence in managing their health condition, reduce carer burden, and enhance clinician satisfaction in their work roles. While neoliberal agendas are focused on self-management and self-responsibility of one's own health care, with technology as a facilitator of this, our findings suggest that the successful use of CHTs for older people with complex health conditions may instead be rooted in co-management. This paper argues that co-management may be a more successful model of care for patients, carers and clinicians. • The use of CHTs in the programme encouraged health responsibilisation. • However, this was not through individual healthcare responsibilisation. • Rather, CHTs facilitated health co-management between patient, carer and staff. • Benefits included increased patient confidence and enhanced staff satisfaction. • Co-management may be a more successful model of care for these patients. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on implementation of tools which capture two key aspects of self-management support - education (guidebooks for patients) and forming collaborative partnerships (a shared decision-making tool). Objectives: To evaluate the implementation and embedding of self-management support in a United Kingdom primary care setting. Design: Qualitative semi-structured interviews with primary care professionals. Settings: 12 General Practices in the Northwest of England located within a deprived inner city area. Participants: Practices were approached 3-6 months after undergoing training in a selfmanagement support approach. A pragmatic sample of 37 members of staff - General Practitioners, nurses, and practice support staff from 12 practices agreed to take part. The analysis is based on interviews with 11 practice nurses and one assistant practitioner; all were female with between 2 and 21 years' experience of working in general practice. Methods: A qualitative design involving face-to-face, semi-structured interviews audio- recorded and transcribed. Normalisation Process Theory framework allowed a systematic evaluation of the factors influencing the work required to implement the tools. Findings: The guidebooks were embedded in daily practice but the shared decision- making tools were not. Guidebooks were considered to enhance patient-centredness and were minimally disruptive. Practice nurses were reluctant to engage with behaviour change discussions. Self-management support was not formulated as a practice priority and there was minimal support for this activity within the practice: it was not auditable; [ABSTRACT FROM AUTHOR]

Abstract: In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment must be addressed. These findings will interest other healthcare commissioners in developing their own approaches to priority-setting. [Copyright &y& Elsevier]

Abstract: Access to transport is an important determinant of health, and concessionary fares for public transport are one way to reduce the ‘transport exclusion’ that can limit access. This paper draws on qualitative data from two groups typically at risk of transport exclusion: young people (12–18 years of age, n = 118) and older citizens (60+ years of age, n = 46). The data were collected in London, UK, where young people and older citizens are currently entitled to concessionary bus travel. We focus on how this entitlement is understood and enacted, and how different sources of entitlement mediate the relationship between transport and wellbeing. Both groups felt that their formal entitlement to travel for free reflected their social worth and was, particularly for older citizens, relatively unproblematic. The provision of a concessionary transport entitlement also helped to combat feelings of social exclusion by enhancing recipients' sense of belonging to the city and to a ‘community’. However, informal entitlements to particular spaces on the bus reflected less valued social attributes such as need or frailty. Thus in the course of travelling by bus the enactment of entitlements to space and seats entailed the negotiation of social differences and personal vulnerabilities, and this carried with it potential threats to wellbeing. We conclude that the process, as well as the substance, of entitlement can mediate wellbeing; and that where the basis for providing a given entitlement is widely understood and accepted, the risks to wellbeing associated with enacting that entitlement will be reduced. [Copyright &y& Elsevier]

Abstract: Aims/background: The retention of student nurses continues to concern the education sector internationally. Evidence shows that individual factors are correlated with a high risk of attrition, including age, disability, entry qualifications, financial issues, and placement experience. This paper is a report of a study that aimed to examine factors connected to progression and attrition by mapping student characteristics against Year 1 progression data. Method: The study used a retrospective cohort design. Students within five cohorts in a single University in the north of England were invited to be included (n =807). Quantitative data were collected from the University''s information system (October 2009–January 2010). Of the total potential participants, 695 were included (13.8% excluded). Multinomial logistic regression was used to ascertain factors that predicted progression. Results: As age on entry increased, the likelihood of non-progression from year one became less: i.e. older students appeared to be more likely to progress than their younger counterparts (p <0.001, likelihood ratio chi-square test). Students who lived away from the local area outside term-time were significantly less likely to progress than those whose term-time and holiday domicile were the same (p =0.007, likelihood ratio chi-square test). Students with dependents or previous care experience seemed more likely to progress than those without, although this was not statistically significant in a multivariable regression model. Conclusion: With the changing demographic profile of students, the new ‘all-graduate’ programmes need to consider student characteristics that are correlated with likelihood of progression and not just focus on those that precipitate exit. [Copyright &y& Elsevier]

Abstract: The paper discusses the possibilities technology provides for (re-)shaping healthcare professionals. Drawing upon critical studies of technology and the sociology of professionals, we present findings from a longitudinal study into the introduction of the Electronic Prescription Service (EPS) in Community Pharmacies in England conducted between June 2009 and July 2011. Our case illustrates the conditions that allow technology to shape healthcare professionals and the potential consequences of such shaping. The data collected, which consisted of qualitative interviews and document analysis, and their analysis rests on predictions of future directions and developments of the pharmacy profession through EPS. Specifically, we show that technology has the potential to shape fundamental aspects of pharmacy work such as its nature and values, professional roles, the degree of power professionals can exercise, their jurisdictions and professional boundaries. Drawing upon these changes and on their implications, we argue that the introduction of technology in a healthcare setting does not determine consequences but opens up a field in which processes of de-professionalisation and re-professionalisation occur simultaneously. Their implications for healthcare professionals in the future, remains an open, yet worth exploring, question for the present. [Copyright &y& Elsevier]

Abstract: This paper aims to examine the relationship between parental socio-economic status (SES) and adolescent substance use. The central question posed in the title is approached in two stages. First, theoretical and empirical research in this area is reviewed. Second, data from an ongoing longitudinal study of young people in England (the Peterborough Adolescent and Young Adult Development Study – PADS+) are used to highlight the nature of this relationship in one city. Results from discrete-time event history analyses show that when examining what predicts initiation of substance use, familial and demographic factors emerge as important predictors, but SES does not appear to be relevant. The concluding discussion focuses on whether support is found for hypotheses derived from the existing literature and implications for future research. [Copyright &y& Elsevier]

It is important to understand young children's motivation within Physical Education (PE) so that researchers and teachers can effectively support children's physical, affective, social and cognitive development as well as physical activity (PA) behaviors. However, there is a dearth of motivation research in PE with children under the age of seven due to a lack of developmentally appropriate assessment tools. This multi-study paper outlines the development, content and construct validity of a novel, mixed-method tool to assess young children's psychological needs and behavioral regulation within PE (Motivation Assessment Tool for Physical Education; MAT-PE). Study 1 consisted of the iterative development of the MAT-PE through working with 43 young children (ages 5–6) from three primary schools located within a large city in North West England. MAT-PE version 1 was subsequently examined for content validity in 85 children (ages 5–6) from 12 primary schools located within a large city in North West England and nine independent researchers with expertise in self-determination theory. Study 2 consisted of the development, content validation, acceptability and inter- and intra-rater reliability of the MAT-PE codebook. Study 3 explored construct validity through hypothesis-testing via correlational data. Descriptive data captured through the MAT-PE and codebook with 78 children (ages 5–6) from 12 primary schools located within a large city in North West England is also presented. The MAT-PE and its codebook were judged to have promising content validity, the codebook was deemed acceptable, as well as demonstrating excellent inter- and intra-rater reliability (ICC = 0.90). Regarding construct validity, as hypothesised, all psychological needs were positively correlated and autonomous regulations were negatively associated with amotivation. There were also unexpected correlations such as the negative correlation between intrinsic and identified regulation. Further development of the MAT-PE is required; nevertheless, this study has taken a promising first step in developing a tool to comprehensively measure five-to six-year-old children's motivational perceptions in PE. • Developed the Motivation Assessment Tool for Physical Education (MAT-PE). • Assesses basic psychological need satisfaction and behavioral regulation in PE. • Mixed method assessment suitable for use with young children (5-6 years old). • Initial findings demonstrate that the MAT-PE has promising validity. • More research is required to further develop and improve the MAT-PE. [ABSTRACT FROM AUTHOR]

The introduction of lower strength alcohol products results in less absolute alcohol purchased. This paper estimates the potential impact of price in shifting British household purchases from higher to lower strength beers and ciders. Descriptive statistics and controlled interrupted time series analyses using Kantar Worldpanel's British household purchase data from 70,303 households during 2015–2018 and the first half of 2020. No and low-alcohol products were less likely to be on price promotion than higher strength products. No and low-alcohol beers were cheaper per volume than higher strength beers; the reverse was the case for ciders. With the exception of low strength ciders (which had very few purchases) a higher volume was purchased when the product was on price promotion than when not. Again, with the exception of low strength ciders, the cheaper the cost, the greater the volume of purchase, more so when the product was on price promotion. The introduction of minimum unit price in Scotland (when controlling for changes in Northern England) and in Wales (when controlling for changes in Western England) shifted purchases from higher to lower strength products, more so for ciders than beers. In relative terms, the alcohol by volume of beer dropped by 2% and of cider by 7%. Changes did not differ by household income or the age of the main shopper. There are opportunities for governments and alcohol producers and retailers to facilitate shifts of purchases from higher to lower alcohol strength products. Alcohol producers and retailers can ensure that the price of lower strength products is competitive vis a vis higher strength products. Governments can introduce minimum unit prices for the sale of alcohol, as has been done in Scotland and Wales. No funding was received for this study. • New no and low alcohol beers result in households buying less alcohol overall. • Alcohol-free and low alcohol beers and ciders are less likely to be on price promotion. • Price promotions increase volume of purchased alcohol-free and low alcohol products. • Cheaper prices increase volume of purchased alcohol-free and low alcohol products. • Setting a minimum unit price shifts purchases from higher to lower strength products. [ABSTRACT FROM AUTHOR]

• Assessment of parental capacity to change is a neglected topic in cases of maltreatment or serious concern about a child. • C-Change is a new capacity to change assessment method for social workers and was well-received in practice. • C-Change training appeared to lead to improved skills and understanding of capacity to change. • Limited evidence that using C-Change in practice may help improve decision-making for children's futures. • Further evaluation of C-Change and the assessment of parental capacity to change is necessary. After identifying a gap in social work practice in the UK, the authors developed and piloted a practice method for use by social workers in assessing parental capacity to change where there are serious concerns about the wellbeing of a child. The purpose of this paper is to present the results from the pilot evaluation of the C-Change approach to assessing parental capacity to change. One hundred and seven (n = 107) social workers and family support workers from three local authorities in England, were trained and supported to use the approach in practice. Feedback questionnaires and self-efficacy style questionnaires were administered to all participants before the training (T1), at the end of the training (T2), and three months after the training (T3). Qualitative interviews were held with a sub-sample of 12 participants. Most of the respondents (87%) at three-month follow up (n = 53) had used the C-Change approach in practice and self-efficacy questionnaire scores of the social workers and family support workers were significantly higher than they were before the training (p <.001, r = 0.25). Limited but statistically significant improvements in (self-assessed) decision-making abilities within the child's timescale were evidenced (p <.05, OR = 2.9). Findings should be approached cautiously because the study used predominantly self-report measures, there was no comparison group and the study was led by the team that developed the C-Change approach. The C-Change approach was well-used by practitioners and their supervisors. There were improvements in their self-reported knowledge and skills in assessing capacity to change, and there was some limited evidence that the C-Change approach may support improvements in decision-making. [ABSTRACT FROM AUTHOR]

In the UK and the Westernised countries, most people die aged 80+ from disabling, chronic and degenerative diseases, having spent several years in poor health. There is thus continuity between long-term care (LTC) and end of life care (EOLC) in old age, but this continuity is poorly understood within policy and almost nothing is known about what determines the modality and intensity of LTC provision in old age towards the end of life. Drawing on multinomial logistic regression analysis of the English Longitudinal Study of Ageing (ELSA), this paper evaluates how health and socio-demographic factors affect the relative probability of receiving care through one of five long-term care arrangements (LTCAs) from the time of need at age ≥50 to death; and assesses the consequences this has for the English LTC and EOLC policy and planning. The study reveals that hospices provide end-of-life LTC for cancer diagnoses and adults aged 50–64, while care homes provide open-ended and end-of-life LTC for non-cancer diagnoses, dementia, severe disability, and adults aged 80+. Further, the informal, formal, mixed and care home LTCAs reflect increasing levels of disability and ill-health, and decreasing levels of family support, with differences concerning education and gender. Finally, dementia and Parkinson's disease are the single strongest determinants of high formal LTC provision, and overall high care needs determine high formal LTC provision. Within the English context, the consequences of this are that: 1) Continued reliance on informal family care is not sustainable; 2) To provide free formal LTC to old adults with high care needs is appropriate; and 3) Hospices do not cater for the prevalent form of dying in old age while care homes do, being the de facto hospices for severely disabled, very old (80+) adults with dementia. Yet this is not represented in English EOLC policy and research. • In England, most people die aged ≥80 from dementia or chronic diseases. • However, little is known about what determines LTC and EOLC arrangements in old age. • Care homes cater for the prevalent form of dying (aged ≥80, with dementia). • Dementia and Parkinson's disease are the strongest determinants of high formal LTC. • Reliance on informal family care more than already done is not sustainable. [ABSTRACT FROM AUTHOR]

This paper explores how adolescents perceive the role and impact of Information and Communication Technology (ICT) use in Cyber Dating Violence (CDV), and whether CDV results in unique experiences or impacts compared to that of offline Adolescent Dating Violence (ADV). Fifty-four adolescents (52% male) aged 13–16 (M = 13.8) participated in focus groups analysed using thematic analysis. Two superordinate themes identified the role of ICT in CDV as (1) enabling and (2) disenabling potential instigators and/or victims of CDV. The findings highlight implications for educating adolescents about the nature and impact of CDV and for promoting constructive and healthy responses to abuse in relationships. • Adolescents perceive ICT to have both enabling and disenabling aspects for victims and instigators of CDV. • ICT is viewed as enabling instigators of CDV by facilitating CDV behaviours. • ICT is viewed as enabling victims of CDV to distance themselves from, report, respond to, and cope with indirect abuse. • ICT is viewed as disenabling victims of CDV due to its unique and potentially more harmful impact than offline abuse. • Implications are raised for educating adolescents about CDV and healthy responses to abusive experiences in relationships. [ABSTRACT FROM AUTHOR]

Local authorities in England are required to routinely collect administrative data on children in care and cross-sectional analyses of national data are published by central government. This paper explores the usefulness of undertaking a longitudinal analysis of these data at local authority level to determine the care pathways for children entering care, differentiating by age at entry. The sample consisted of 2208 children who entered care in one English local authority over a six-year period, and who were followed up for at least 2 years. A logistic regression model was fitted to explore factors associated with children staying long term in care. Age at entry was a key determinant of where children ended up (return to a parent, special guardianship or residence order, adoption or staying long term in care). Only a minority of entrants (mainly those entering care in their middle years) remained in longer term care. For the vast majority of children, the 'pre-care family context' remains important as children will either return to parents or relatives or stay in touch with them. The findings are used to urge service planners to make full use of data on care entrants, especially age at entry, when deciding on the balance between the different placement options needed, and the social work service delivery models. • After two years in care over one third of children (37%) had returned to their parents. • Just under one third of children (31%) stayed at least two years in care. • Age at entry was a very strong predictor of where children ended up. • Children age 0–2 were more likely to be adopted than any other outcome. • More than half (51%) of children entering care age 7–11 stayed long term in care. [ABSTRACT FROM AUTHOR]