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Rationale, aims and objective: Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting. Method: The systematic review was performed using the PICO framework. Original papers in which the premise of the intervention was to substitute outpatient hospital care with primary care through the involvement of a medical specialist in a primary care setting were eligible. Results: A total of 14 papers were included. A substitution intervention in general practitioner (GP) practices was described in 11 papers, three described a joint consultation intervention in which GPs see patients together with a medical specialist. This study showed that substitution initiatives result mostly in favourable outcomes compared to outpatient hospital care. The initiatives resulted mostly in shorter waiting lists, shorter clinic waiting times and higher patient satisfaction. Costs for treating one extra patient seemed to be higher in the intervention settings. This was mainly caused by inefficient planning of consultation hours and lower patient numbers. Conclusions: Despite the fact that internationally a lot has been written about the importance of performing substitution interventions in which preventing unnecessary referrals to outpatient hospital care was the aim, only 14 papers were included. Future systematic reviews should focus on the effects on the Triple Aim of substitution initiatives in which other healthcare professions than medical specialists are involved along with new technologies, such as e-consults. Additionally, to gain more insight into the effects of substitution initiatives operating in a dynamic healthcare context, it is important to keep evaluating the interventions in a longitudinal study design. [ABSTRACT FROM AUTHOR]

Horses in Great Britain are living into increasingly older age and are often regarded as friends or family members by their owner. The horse is reliant on their owner to meet their needs and this paper discusses how horse owners frame an issue that becomes a matter of veterinary concern within the context of the older horse. Qualitative methods were used to explore the experiences of owners and veterinarians. Data were collected and analysed using a grounded theory approach during the period 2019-2022. Analysis identified that owners undertook an ongoing and iterative process of assessment, monitoring and decision making in relation to the animal and any changes they observed. Matters that became a veterinary concern required the owner to formulate the issue as something that fell within the knowledge domain of the veterinarian. Veterinarians had a medicalised view of older horse health and their perspectives on socially acceptable care were shaped by their understanding of speciesspecific needs, and whether owners were providing appropriately for those needs. The formulation of a matter of veterinary concern was itself shaped by an owner's experiential knowledge of both veterinary matters and their horse. The extent to which owners felt like they and their individual horse mattered during interactions with veterinarians affected whether they adopted veterinary advice and the nature of future veterinary employment. Findings demonstrate how matters of health, disease, and the role of professionalised forms of medical knowledge, are not static but constantly changing and interacting over time. An issue that became a matter of veterinary concern was contextual, and rooted in individual relationships. The significance of veterinarian-owner interactions in shaping future consumption of veterinary health care may be underestimated. [ABSTRACT FROM AUTHOR]

Introduction: To meet the ambition of the UK becoming the global leader in health technology, the future workforce needs to have a developed digital literacy. The influence of the COVID-19 pandemic on the move to online learning has also increased the requirement for a reinvention of traditional teaching methodologies (Sá & Serpa, 2020). Methodology: A systematic review was conducted using a mix of Boolean search terms in twelve education and health journal databases to discover the extent of current international research of digital literacy in health programmes. Papers were selected for their specificity to digital literacy in health education pre-registration professional programmes. Results: The initial search included 5359 papers, 3925 after duplicates removed, 134 remained after title review which were then input into Covidence for full reading, finally 47 papers being included for thematic analysis. This thematic analysis identified a number of key themes within these papers: digital literacy of the educator, digital literate workforce, technical skills limit adoption, information literacy, a curriculum requirement in education, institutional infrastructure or personal access, preparedness for entering academia, concerns over the use of digital skills, personalised digital literacy experience, increased communication skills with digital literacies, competency frameworks, COVID-19 and social media in education. Conclusion: This research identifies areas of good practice and areas that need to be considered in higher education programmes and by academics to ensure the digital literacy of the future healthcare workforce. [ABSTRACT FROM AUTHOR]

People with intellectual disabilities face health disparities, including in high‐income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID‐19 pandemic, and the implementation of the Valuing People white paper are discussed. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to identify the existing literature on the wide range of operations research (OR) studies applied to healthcare, and to classify studies based on application type and on the OR technique employed. The scope of the review is limited to studies which have been undertaken in the UK, and to papers published since the year 2000. Design/methodology/approach – In total, 142 high-quality journal and conference papers have been identified from ISI Web of Knowledge data base for review and analysis. Findings – The findings categorise the OR techniques employed, and analyse the application type, publication trends, funding, and software packages used in the twenty-first century in UK healthcare. Publication trends indicate an increasing use of OR techniques in UK healthcare. The findings show that, interestingly, the distribution of the OR techniques employed is not uniform; the majority of studies focus on simulation, either as the only technique employed or as one element of a multi-method approach. Originality/value – Several studies have focused on the use of simulation in healthcare modelling, but none has methodologically reviewed the use of the full range of OR techniques. This research is likely to benefit healthcare decision makers since it will provide them with an overview of the different studies that have utilised multiple OR techniques for investigating problems in the stated domain. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of "upstreamist", health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department. Design/methodology/approach: Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of "upstreamist" system leadership to advance the integration of health care. Findings: Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with "upstreamist" system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED. Research limitations/implications: At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services. Practical implications: This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps. Originality/value: To the best of the authors' knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop "Esther" patient-centred approaches in the design of integrated health and care services. [ABSTRACT FROM AUTHOR]

Purpose: The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries. Design/methodology/approach: The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy. Findings: Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations. Originality/value: This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers. [ABSTRACT FROM AUTHOR]

Introduction: Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. Methods: The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Results: Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007–2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were ‘medical professionals’, ‘area of competence’, ‘impact on time’ and ‘service’. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Discussion: Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to offer a personal interpretation of the nature and impact of alternative narratives of public management reform evident in the UK since the 1980s. These reforms are examined through the prism of alternative bodies of public management scholarship. They are applied to the specific case of the health care sector as a concrete focus. Design/methodology/approach -- The study is a personal overview of various streams of policy reforms in the UK health care sector and associated public management scholarship. This is an interpretive essay. Findings -- The new of public management remains the dominant reform, narrative and highly embedded, even if dysfunctionally so. Network governance reforms have had some enduring influence. Digital era governance has so far had only weak influence. A reprofessionlisation counter narrative shows variable and oscillating influence. Originality/value -- The study contributes to a developing narrative-based stream in public management scholarship. It also provides a "big picture" assessment of reforming in the UK health care sector since the 1980s. [ABSTRACT FROM AUTHOR]

Aim and objective: To identify training strategies and determine how registered health and social care practitioners change their practice after Mental Capacity Act training. Design: Narrative literature review. Data sources: Seventeen databases were searched up to December 2019: CINAHL, Social Care Online, PubMed, Social Policy and Practice, Discover, MEDLINE, Science Direct, Ovid, 0of Science, British Nursing Index, DH‐Data and King's Fund Library Catalogue. Review Methods: Empirical studies of any design investigating Mental Capacity Act training were searched and screened. Data were extracted to a bespoke spreadsheet and quality assessed. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Results: Of 162 papers identified, 16 were included comprising qualitative, quantitative and mixed‐methods studies. Trainees valued interactive training with close alignment to practice. Training did not lead to demonstrable practice change. Barriers in the context and cultures of care environments were identified. Conclusion: To facilitate application of Mental Capacity Act legislation, identified barriers should be addressed. Future training should be interactive, scenario‐based and relevant to trainees' practice. Relevance to Clinical Practice: The Mental Capacity Act is widely misunderstood and implemented poor. Training is proposed as a solution, but the nature of training that will positively affect practice remains unknown. This review aims to address this gap in the evidence base. Interactive training, using scenarios that reflect practice complexities, has the most positive impact. Cultural norms in care environments may impede application of this legislation. The review has international relevance as there is a global imperative to adhere to the United Nations Convention on the Rights of Persons with Disabilities. The review will inform training design and delivery to ensure that people with impaired capacity to make decisions are given the best opportunity to act autonomously. [ABSTRACT FROM AUTHOR]

Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the ‘Girls Active’ secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the ‘Girls Active’ programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, ‘Girls Active’ costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb ‘Girls Active’ strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the ‘Girls Active’ programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, . [ABSTRACT FROM AUTHOR]

Introduction: Non-medical prescribing was introduced into the United Kingdom (UK) to improve patient care, through extending healthcare professionals’ roles. More recent government health service policy focuses on the increased demand and the need for efficiency. This systematic policy review aimed to describe any changes in government policy position and the role that non-medical prescribing plays in healthcare provision. Method: The systematic policy review included policy and consultation documents that describe independent non-medical prescribing. A pre-defined protocol was registered with PROSPERO (CRD42015019786). Professional body websites, other relevant websites and the following databases were searched to identify relevant documents: HMIC, Lexis Nexis, UK Government Web Archive, UKOP, UK Parliamentary Papers and Web of Science. Documents published between 2006 and February 2018 were included. Results and discussion: Following exclusions, 45 documents were selected for review; 23 relating to policy or strategy and 22 to consultations. Of the former, 13/23 were published 2006–2010 and the remainder since 2013. Two main themes were identified: chronological aspects and healthcare provision. In the former, a publication gap for policy documents resulted from a change in government and associated major healthcare service reorganisation. In the later, the role of non-medical prescribing was found to have evolved to support efficient service delivery, and cost reduction. For many professions, prescribing appears embedded into practice; however, the pharmacy profession continues to produce policy documents, suggesting that prescribing is not yet perceived as normal practice. Conclusion: Prescribing appears to be more easily adopted into practice where it can form part of the overall care of the patient. Where new roles are required to be established, then prescribing takes longer to be universally adopted. While this review concerns policy and practice in the UK, the aspect of role adoption has wider potential implications. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between dyslexia, homelessness and access to health and social services. This is a quantitative study analysing data from the Multiple Exclusion Homelessness across the United Kingdom Survey. Data was collected from 443 participants who had experienced some form of homelessness in the UK. A comparison was made between people with dyslexia and those homeless people without this condition. The data findings in this paper appear to reveal that people with dyslexia are overrepresented within the survey's homeless population. It may be expected that people with dyslexia might not come in contact with health professionals and social workers as support for this condition generally takes place within an educational environment. Yet this study seems to indicate that homeless people with dyslexia have greater contact with health professionals and social workers compared with non-dyslexic homeless people. This paper suggests that health and social services need to consider conditions like dyslexia in order to develop support for this particular group of people that have experienced homelessness. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to consider the use of surveillance technologies in care homes and the way in which they can help protect older people. It signals an ethical way forward for their use that de-fuses the heightened rhetoric associated with concerns about the abuse. Totally, seven principles are put forward by which the use of surveillance technologies can be supported. Design/methodology/approach – The paper recognises the significance of technological developments and the key part that they now play in helping people live more independently. Surveillance technologies have a part in this within care homes, but there are important ethical considerations – notably around the way in which concerns for privacy are balanced with those about people’s safety and autonomy. Findings – The paper points to an approach that can guide the use of surveillance technologies within care homes. The seven principles put forward will be built on through further work in 2015 including care home residents, family carers, formal care providers and others. In setting out these principles the paper mediates between the positions of those who argue the merits of such technologies and those who point to some of them, notably cameras, as undermining people’s privacy and the nature of the “care relationship”. Originality/value – The subject matter of the paper is important because of the attention being given to problems of abuse in care settings; and the freedom by which anyone can access technologies that can be used for surveillance. The paper is timely and carries substantial originality. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to introduce and present the first findings of a new English performance indicator in the primary healthcare of adults with Down syndrome. This is a performance target, with associated bonus payment, requiring General Practitioners (GPs) to undertake annually a screening blood test for thyroid hormone deficiency. Design/methodology/approach – Analysis and review of data collected from all GP practices and published by the National Health Service (NHS) Information Centre. Findings – In total, 82 per cent of those identified as in the target group were screened and 10 per cent were identified as not wanting to be screened or screening inappropriate. The target group numbered just over 60 per cent of the number estimated from epidemiological and other studies. The numbers of cases involved is small (0, 1 or 2 cases in 75 per cent of GP practices), and whilst variation in coverage at local level appears important, numbers are too small for the variations seen in the first year's data to be statistically significant. The scope of the data precludes useful strategic analysis of the value of the intervention. Research limitations/implications – Data from several years need to be taken together. The NHS Information Centre should slightly increase the scope of the data to allow analysis of whether the programme is having useful public health benefits. Originality/value – The paper examines a new data source and makes points applicable to a wider range of similar datasets in the same programme. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to provide an overview of the Achieving Age Equality Toolkit, to give the background to its development, and to advise readers of the ways in which it has already been successful in the health and social care arena. Design/methodology/approach – The subject of this paper is the ban on age discrimination in goods and services that came into force on 1 October 2012. The objectives of the paper are achieved by setting out the policy context, and by detailing how the age equality recommendations were made through an independent review. Findings – Older people have different experiences of health and social care services, but most want to be able to access support when they need it. Age as a barrier to treatment and screening in areas such as mental health and cancer continue to give cause for concern. Organisations need to ensure they are working in an "age equal" way across services. Research limitations/implications – Implications for further research could include an assessment of the extent of "institutional ageism" in services after the ban on age discrimination in goods and services on 1 October 2012. Practical implications – The article illustrates through case studies how use of the toolkit enables one organisation to better identify where changes are needed towards embedding anti age discrimination practice. Social implications – As well as obeying legal requirements, ending age discrimination in health and social care requires a change in hearts and minds towards encouraging society to think differently about the ways in which older people are supported by health and social care services. Originality/value – Since the review, there have been repeated cases of age discrimination in goods and services, illustrating the need for change. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to summarise findings of a review of service user and carer involvement in safeguarding and recommendations for good practice. Design/methodology/approach -- The study involved a review of selected literature and a consultation exercise with experts in the field of adult safeguarding and telephone interviews with 13 Adult Safeguarding Leads across England and Wales. Findings -- Service users value rights, independence, choice and support. Adult Safeguarding policy sets out an expectation of service user involvement in the process and expects agencies to balance rights to self-determination with properly managed risk. In practice, agencies tend to be risk-averse and service users often do not feel involved in their safeguarding processes. Processes such as collaborative risk enablement, training and capacity building, working with BME groups and evaluation of involvement help. Good practice examples of involvement in Safeguarding Boards or local forums, developing new methods of user feedback and community involvement were found. Recommendations include more involvement of service users in research, more effective forms of involvement of groups who may be more excluded, shared responsibility for risk, and more training in rights legislation. Practical implications -- The paper offers recommendations for good practice in improving involvement in adult safeguarding, which is a requirement and an essential component of delivering good services to vulnerable adults. Originality/value -- Service user involvement in health and social care is now widespread, but there is little knowledge of how to involve the most vulnerable service users who are in need of protection, or how to balance risk and empowerment. This paper addresses the dilemmas facing Adult Protection staff, summarises the experience of practitioners based on the first decade of adult safeguarding work and sets out guidance for improving practice. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to identify and review the leadership challenges in workforce planning, paying special reference to adult social care primarily in England (UK) whilst raising leadership issues that have international resonance. Design/methodology/approach – This is a viewpoint which presents a distillation of key issues, challenges and relevant literature spanning workforce planning, human resources and social care. Findings – The paper finds that growing demands on services, rising expectations for personalised care and support, together with the provision of safe and effective joined up care are some of the key drivers facing social care and wider public services. Leaders need to ensure a robust data and evidence base, sound interpretation of intelligence as well as building integrated approaches to workforce planning both within and between services. Practical implications – Workforce leadership provides the bedrock to ensuring social care builds the workforce required for the future. As services undergo redesign and transformation the workforce planning task is more important now than ever and is a key responsibility for every organisation's leadership, including chief executives, commissioners and workforce specialists. Originality/value – Workforce planning in social care is afforded relatively little attention and the analysis presented in this paper provides the stimulus for debate. [ABSTRACT FROM AUTHOR]

This paper examines differences in health-and-social care utilisation for individuals with physical and/or mental health problems. Logistic regression models are used to determine disparity in the percentage of General Household/Lifestyle Survey participants with physical compared to mental health problems receiving disability benefits or health care services between 2000 and 2011. Our findings of a relative underutilisation of secondary health care combined with a relative overutilization of out-of-work benefits by individuals with mental health problems is novel to the field of rehabilitative health care. These results provide evidence for the previously suspected disparity in health care utilisation of individuals with mental health problems and indicate problems in labour force integration. The findings support the political call for a 'parity of esteem', which, in Britain, was enshrined in the Health and Social Care Act of 2012. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

There is a long history in science and technology studies (STS) of tracking problematic objects, such as controversies, matters of concern, and issues, using various digital tools. But what happens when public problems do not play out in these familiar ways? In this paper, we will think through the methodological implications of studying "problems" in relation to recent events surrounding the sharing of patient data in the National Health Service in the United Kingdom. When a data sharing agreement called care.data was announced in 2013, nearly 1.5 million citizens chose to opt out. Yet, in subsequent years, there has been little evidence of a robust public mobilising around data sharing. We will attempt to track this elusive 'non problem' using some digital tools developed in STS for the purpose of mapping issues and problem definitions within science. Although we find these digital tools are unable to capture the "problem," the process of searching helps us map the terrain of the case and forces us to consider wider definitions. [ABSTRACT FROM AUTHOR]

Background: The accessibility of services within community pharmacies provides an ideal opportunity to manage minor ailments, yet over £1.1 billion is spent by the National Health Service (NHS) in the United Kingdom (UK) in managing minor ailments in high cost settings. There is a need to review the evidence base around clinical effectiveness of pharmacy-based management of minor ailments since the absence of such may lead to under-utilisation of pharmacy services and non-implementation of available pharmacy service models. This study aimed to systematically review the methodological approaches used to assess clinical outcomes of pharmacy-based management of minor ailments in the research literature. Methods: A systematic review was conducted to identify relevant literature using the following databases: Medline, EMBASE, CINAHL, IPA, CRD, CDSR, and Google Scholar from publication year 2000 onwards. Studies were included if they evaluated clinical outcomes of pharmacy-based management of any minor ailments, with or without a comparator setting such as Emergency Departments (EDs) or general practices. Screening and selection of titles, abstracts and full texts followed by data extraction and quality assessment (QA) was conducted. Paired researchers, from the team, reviewed papers using a protocol based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). QA was undertaken using the Critical Appraisal Skills Programme (CASP). Reporting was conducted in accordance with PRISMA checklist and statements. Results: A total of 19 studies were included. The majority of studies were observational, conducted in community pharmacies, and did not use a comparator participant group nor a comparator setting. Interventions included counselling, medicines supply and provision of advice on the management of minor ailments. One study used the randomised controlled trial (RCT) design with majority of the study utilising observational design. A range of clinical outcomes including symptom severity, pattern, resolution, and quality of life were reported. Methods used for the assessment of clinical outcomes were, overall, poorly reported. This included a lack of information on the development and validation of the data collection tools and the timing of baseline and follow-up data collection. Adverse clinical outcomes data were collected by only seven studies. Conclusions: Currently, there are methodological limitations in the studies that have sought to assess clinical outcomes of pharmacy-based management of minor ailments. Such lack of high quality evidence may contribute to failings to shift care from high cost settings, such as EDs and general practices. Generation of high quality evidence is likely to influence public choices when seeking care for minor ailments. There is scope for development of a core outcomes set specific to minor ailments management and development of a validated methodology for measuring such outcomes in a research study. [ABSTRACT FROM AUTHOR]

Personhood discourses in dementia care have gained prominence and current care home standards mandate that care should be “person-centred”. However, it is unclear how the personhood of staff is construed within the care relationship. This paper aims to explore how the personhood of paid carers of people with dementia can be understood by focussing on the views and experiences of care home staff. We undertook a secondary qualitative analysis of interviews with 25 paid care staff in England, conducted as part of the MARQUE (Managing Agitation and Raising QUality of lifE) study. The authors inductively developed themes around the topic of personhood for staff, contrasting management and care staff perspectives. We found that many care staff are not identified as persons in their own right by their employing institutions, and that there is a general lack of acknowledgment of the moral work of caring that occurs within formal care work. This oversight can reduce the complex relationships of care work to a series of care tasks, challenges care workers’ self-worth and self-efficacy, and impede their efforts to deliver person-centred care. We conclude that care staff status as persons in their own right should be explicitly considered in quality standards and supported by employers’ policies and practices, not simply for their role in preserving the personhood of people with dementia but for their own sense of valued personhood. Enhancing staff personhood may also result in improved care. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to determine the appropriate legal balance and framework whereby issues of health care, patient access and rights of conscience can be best accommodated. Design/methodology/approach - A review of existing case law, statutes and conscience clauses as applied to the philosophical debate surrounding conscience in health care. Findings - Freedom of conscience is strongly anchored in British law and policy. Practice within the health care industry, however, has been slow and resistant to rights of conscience. Respecting the right of health care workers to exercise that right, benefits the health care industry at large and patients themselves. Originality/value - This debate, particularly since the so-called "Scottish mid-wives case" and the recent General Pharmaceutical Council consultation on religion and personal values, has come to the forefront of bio-ethical discourse in recent months. As such, this treatment provides a valuable legal tool to answering the various positions involved in the debate. [ABSTRACT FROM AUTHOR]

Purpose – This paper critically reviews the motivations for introducing different connected healthcare to support Assisted Living in older and other vulnerable groups. The aim is to develop a new approach that will be sustainable in the future. Design/methodology/approach – The methodology involves a consideration of assessment criteria currently being employed and the resulting costs and limitations in providing a person centred approach. The implications of introducing new technologies such as plesiocare and mCare are then considered. Findings – It was found that one of the most cost-effective applications of technology is in the support of informal carers but the telecare equipment that they are offered may not be the most appropriate. Research limitations/implications – The findings are limited by a lack of formal risk assessments that are person centred. The implications include the need for improved training in assessment processes and access to a wider inventory of technologies. Practical implications – Existing telecare services will need to change in order to adopt more plesiocare and self-care approaches and to engage more actively in the development of models based on mcare. Social implications – Governments and health ministries may achieve better and lower cost support for their ageing population by adopting a model that includes multiple layers of technology, including easier access to self-care and mCare technologies. Originality/value – This paper includes the first discussion on plesiocare and its relative advantages over telecare in supporting informal carers. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to highlight the benefits of the 360 SF diagnostic audit for assessing person centeredness of a domiciliary agency and to highlight the challenges they face with some suggested actions. These are exemplars of what is raised in policy and recent reports relating to personalisation, dignity and integration of health and social care and have wider implications for all agencies as they strive to resolve issues for the client. Design/methodology/approach – The approach is a case study describing results of the audit in relation to challenges that include practice development needs, inter agency co-ordination, collaboration and co-operation for the achievement of relationship based person centered outcomes in quality improvement work. The pilot study involved data gathered from the clients, relatives and staff, which were analyzed resulting in findings, conclusions and suggestions for ongoing improvement from which action plans were devised and implemented. Findings – The audit results provide examples of the primary interface relationship and co-ordination challenges, highlighting leaning needs for staff delivering person centred care in domiciliary settings. Practical implications – This paper raises important practice development issues both inside and outside the agency's responsibility. Use of the tool would support cultural and interface relationship issues affecting the client experience and highlight ways to assist the achievement of collaborative ways of working needed for the integration of health and social care. Social implications – The 360 SF (DS) can help organisations provide evidence to CQC and the public for their performance and identify the close interface relationships and their effectiveness in delivering co-ordinated and integrated health and social care. Originality/value – The 360 SF DOM has highlighted with evidence the challenges of the systemic culture at the interface, in particular the nature and quality of collaboration, communication and practice development needs across the organisational divide to deliver person centred care and support. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore the introduction of teamwork in two health call centres, NHS Direct and NHS24, and intervenes in the emergent debate over teamwork in call centres. Although within the call centre work environment there is no obvious functional rationale for teamwork, teams can be "accounted for" with reference to other purposes, including performance management, normative control, governmentality and institutional isomorphism/management fads. This research provides additional explanations for the use of teamwork in such an adverse work environment. Design/methodology/approach – The paper is based on qualitative data (interviews and non-participant observations) from NHS Direct and NHS24, the English and Scottish tele-nursing organisations in the UK. Findings – In the two tele-nursing case studies analysed, teamwork was introduced as an expression of managers' aspirations to emulate private sector practices and to reinforce new public management ideals. However, informal teamwork, which cut across organisationally prescribed forms, provided both emotional support and spontaneous knowledge sharing among nurses. Originality/value – This is an innovative study because teamwork has not been thoroughly explored in a health call centre environment. [ABSTRACT FROM AUTHOR]

In 2009 I entered the interdisciplinary collaborative world through the Engineering for Life (EfL) - Enhancing Peoples' Lives project at Sheffield Hallam University, UK, funded by the Engineering and Physical Sciences Research Council under the 'Bridging the Gap' initiative. As a Research Fellow and a research coordinator my role in the scheme was to contribute to the creation and development of multidisciplinary research networks and innovative multidisciplinary projects, as well as to reflect upon ongoing interdisciplinary collaborations. Being a dance scholar and practitioner, as well as a biologist, I was interested in the 'third culture', performative science and the theory and practice of interdisciplinarity including all the debates and reactions it raises. The paper discusses the model applied by the EfL in order to generate some novel interdisciplinary research ideas, focusing particularly on their development through the different performance techniques explored during the Ideas generator or Sandpit events. [ABSTRACT FROM AUTHOR]

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. The AMED, CINAHL, EMBASE, Medline and psychINFO databases were searched for original study articles in English, dating from 1974 to 2008. Review articles and expert opinion were excluded. Each study had two independent reviews by either a general practitioner or specialist in rehabilitation medicine. Each study was critically appraised according to the National Service Framework for Long-term Conditions (Department of Health, 2005a) methodology and recorded on standardised data extraction sheets. Studies of poor quality were excluded. Sixty studies were included. No randomised controlled trials were identified. Studies broadly fell into the following three main groups: database studies (n=27), quantitative surveys (n=20) and qualitative interviews (n=13). Disabled people are restricted in accessing health care and report less satisfaction with their medical care. Many of the identified studies were from the United States (US) and based on subjective reporting. More objective evidence is needed, especially in the UK, to clarify the true level of access to health care in people with disabilities. The complex, interdependent factors in providing health care to disabled people require complex solutions. [ABSTRACT FROM AUTHOR]

While the need for leadership in health care is well recognised, there is still the need to better understand how leadership contributes to improving healthcare services. The body of knowledge concerning improvement has grown significantly in recent years, but evidence about links between leadership and health services improvement remains poor, especially within the UK National Health Service. It remains unclear how and why leadership is important to service improvement, and how leadership development can optimise service improvement.This paper describes a study commissioned by The Health Foundation, exploring the links between leadership behaviours reported by clinicians and managers in NHS organisations and their service improvement work. The study highlights leadership behaviours that appear to be positively associated with NHS improvement work. This paper provides insights into which aspects of leadership are used for different types of improvement work and considers lessons for leadership development. [ABSTRACT FROM AUTHOR]

The concept of the ‘risk society’ has focused on growing uncertainties about the benefits of scientific innovation and the reliability of professional judgement. Paradoxically, this has gone hand in hand with reductions in the actual risk associated with many activities and is often accompanied by demands for a technological fix. These contradictory impulses are especially evident in maternity care. While maternal and infant mortality rates have fallen, risk conscious patients are increasingly concerned about the possibility of professional mistake or malpractice. As a result, further categories of risk are created for organizations and professionals, particularly in relation to expensive litigation. Against this background, the paper reports on an ethnographic study of two delivery suites in which a computerized decision support system will be implemented. In the paper, we attempt to highlight some of the intricacies of work processes in delivery suites, specifically involving decision-making, risk, uncertainty, professional autonomy and medical knowledge. Our findings suggest a range of complexities that may considerably complicate the implementation of the computerized decision support system when it finally emerges and becomes embedded in delivery suites. [ABSTRACT FROM AUTHOR]

Education and training consortia: leading the way for the new British NHS In November 1997 The New NHS — Modern, Dependable was published, describing the British Labour government’s plans to introduce major changes to the NHS (National Health Service). Education and Training Consortia (ETCs) were only briefly referred to and no direct changes were proposed to them. It can be argued that this was because they had not fitted well within the Conservative government’s competitive culture of the NHS internal market. Education Consortia members share information, make plans collectively and work collaboratively, activities much more appropriate for the ‘New NHS’ which is underpinned by the concepts of partnership, openness and local ownership. In this paper it is argued that there are many valuable lessons that the key individuals involved in implementing the policies of the New NHS can learn from Education and Training Consortia. Data have been drawn from a qualitative study in which the aim was to explore the development, implementation and management of consortia and contracting for non-medical education and training (NMET) from a stakeholder’s perspective. One of the unexpected themes that emerged from the analysis of the data, was that the development of ETCs could be utilized as a model for many of the innovations in the New NHS, particularly in relation to the formation of primary care groups. [ABSTRACT FROM AUTHOR]

Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. [ABSTRACT FROM AUTHOR]

Within the context of the U.K. background (public expenditure is being severely curtailed, at a local level health services and social services arc controlled by separate organisations and there are many groups of the population for whom a number of acceptable treatments, or methods of caring, exist), the paper describes the development of a resource allocation model and its use in a local planning situation. Although based on the techniques of mathematical programming, the model does not purport to indicate a single optimum allocation of health and social services resources, but rather to calculate the resource consequences of possible alternative courses of action. As such, its use is seen as iterative, in that health and social services decision makers can review and update their assumptions in the light of the results from successive runs of model. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a case study on the role of motivation in nonfor- profit (NFP) organisations in the UK with particular reference to two organisations providing services to people with learning disabilities. Quantitative data was collected from 88 respondents, through questionnaire based-surveys. Interviews were used to triangulate the data and for validation purposes. The sample used is entirely composed of employees and includes: permanent, temporary, full time and part-time staff and no volunteers. Findings indicate that many individuals are attracted to work in NFP organisations because of their characteristics diversity factors. Other key motivational factors include training, and flexible working arrangements. Overall findings show that people are intrinsically motivated even if employees were not satisfied with the pay. The findings conform to earlier studies on employees' motivation in NFP organisations and on pay and motivations (Tippet and Kluvers 2009). [ABSTRACT FROM AUTHOR]

Purpose – Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the integration agenda. The purpose of this paper is to provide a description and critical account of four models of contracting, namely Accountable Care Organisations, the Alliance Model, the Lead Provider/Prime Contractor Model, and Outcomes-based Commissioning and Contracting. Design/methodology/approach – The approach taken to the literature review was narrative and the results were organised under an analytical framework consisting of six themes: definition and purpose; characteristics; application; benefits/success factors; use of incentives; and critique. Findings – The review highlighted that while the models have relevance, there are a number of uncertainties regarding their direct applicability and utility for the health and social care agenda, and limited evidence of effectiveness. Research limitations/implications – Due to the relative newness of the models and their emerging application, much of the commentary was limited to a narrow range of contributors and a broader discussion is needed. It is clear that further research is required to determine the most effective approach for integrated care contracting. It is suggested that instead of looking at individual models and assessing their transferable worth, there may be a place for examining principles that underpin the models to reshape current contracting processes. Practical implications – What appears to be happening in practice is an organic development. With the growing number of examples emerging in health and social care, these may act as “trailblazers” and support further development. Originality/value – There is emerging debate surrounding the best way to contract for health and social care services, but no literature review to date that takes these current models and examines their value in such critical detail. Given the pursuit for “answers” by commissioners, this review will raise awareness and provide knowledge for decision making. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to consider the criminal offence of wilful neglect in the context of hospital health care in England. Design/methodology/approach -- Summarise the evidence of neglectful care in hospitals and analyse the ingredients and application of the offence of wilful neglect. Findings -- Neglect is ongoing and systemic in the hospitals and the offence of wilful neglect seems to be ineffective as either a punitive or deterrent measure. Practical implications -- There is a mismatch between the extent of systemic, reckless neglect in the hospitals and the application of the criminal offence of wilful neglect. The answer, if any, might be: widening of the offence to anybody who is wilfully neglected (not just those mentally disordered or mentally incapacitated people), a new offence of corporate neglect, the holding of reckless leaders to account, and a reinvigorated Care Quality Commission and Health and Safety Executive. Originality/value -- The author is unaware that such a review of this area of law, applied to health care, has been undertaken. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to bring the discussion on the relationship between management and medicine a step forward by focussing on: first, how the notion of hybrid and hybridity has been used in the literature on healthcare management. Second, the authors have mapped the alternative ways that the concept have been used in order to conceptualize a more specific set of possible combinations of managerial and professional roles in healthcare management. Hybrid management is a topic that ought to be important for training, communication among researchers and for identifying areas of future research: in management, in healthcare reforms, in sociology of professions and in theory of organizations. Design/methodology/approach – The authors provide a systematic literature review in order to map the various conceptualizations of hybrid management. The authors have searched for “hybrid leadership,” “hybrid management” combined with hospitals and health care in a whole range of journals, identified in Google scholar, Academic Search Premier, Academic Research Library and Sage Publication. The authors have also used already existing literature reviews. The search has resulted in more than 60 articles and book titles that have been classified according to whether they make a fit with three alternative ways of conceptualizing hybrid management. The authors are aware that they might have missed some relevant literature but the literature included is quite comprehensive. Findings – In the literature the authors have found three conceptualizations of management. The clinical manager who combines professional self-governance with a general management logic. The commercialized manager who combines professional self-governance with an enterprise logic. The neo-bureaucratic manager who combines self-governance with a neo-bureaucratic logic. Originality/value – In most analyses of hybridity in management and organization the notion of hybrid has been used in a rather superficial way. By mapping the various uses of hybrid in the literature and suggest how a professional logic may be combined with a set of alternative logics of management the authors provide a platform for developing the concept of hybrid management into a more useful tool for analyses of changes in healthcare management. [ABSTRACT FROM AUTHOR]

Background: Wound-edge protection devices (WEPDs) have been used in surgery for more than 40 years to reduce surgical site infection (SSI). No economic evaluation of WEPDs against any comparator has ever been conducted. The aim of the paper was to assess whether WEPDs are cost-effective in reducing SSI compared to standard care alone in the United Kingdom. Methods and Findings: An economic evaluation was conducted alongside the ROSSINI trial. The study perspective was that of the UK National Health Service and the time horizon was 30 days post-operatively. The study was conducted in 21 UK hospitals. 760 patients undergoing laparotomy were randomised to either WEPD or standard care and 735 were included in the primary analysis. The main economic outcome was cost-effectiveness based on incremental cost (£) per quality adjusted life year (QALY) gained. Patients in the WEPD arm accessed health care worth £5,420 on average and gained 0.02131 QALYs, compared to £5,130 and 0.02133 QALYs gained in the standard care arm. The WEPD strategy was more costly and equally effective compared to standard care, but there was significant uncertainty around incremental costs and QALYs. The findings were robust to a range of sensitivity analyses. Conclusions: There is no evidence to suggest that WEPDs can be considered a cost effective device to reduce SSI. Their continued use is a waste of limited health care resources. [ABSTRACT FROM AUTHOR]

This paper offers critical reflection on the contemporary tendency to approach health care in instrumentalist terms. Instrumentalism is means-ends rationality. In contemporary society, the instrumentalist attitude is exemplified by the relationship between individual consumer and a provider of goods and services. The problematic nature of this attitude is illustrated by Michael Oakeshott's conceptions of enterprise association and civil association. Enterprise association is instrumental; civil association is association in terms of an ethically delineated realm of practices. The latter offers a richer ethical conception of the relation between person and society than instrumentalism does. Oakeshott's conception is further illustrated by reflection on the connection between morality and religion that he explores in an early essay concerning 'religious sensibility'. Religious sensibility turns on the acknowledgement of the vulnerability of the self to the vicissitudes of life. This vulnerability cannot be bargained over instrumentally without imperilling the self. Religious sensibility is thus a valuable resource for criticising instrumentalist attitudes. It allows for the cultivation of ethical self-understanding that is essential to comprehending the conditions in virtue of which genuine civil life is possible. These conditions need to be taken into account in health care. Health care is not simply about substantive wants. It also necessarily concerns the universal and constant condition of being prey to illness that is the common lot of all citizens. [ABSTRACT FROM AUTHOR]

This paper considers the way in which English law safeguards fundamental rights to respect for faith and belief in relation to the delivery of health care. It explores the implications of the Human Rights Act 1998 and the Equality Act 2010. It explores some of the challenges in attempting to reconcile fundamental rights to faith and belief and the delivery of health care, both now and in the future and whether this is a realistic aspiration in a state funded health care service. [ABSTRACT FROM AUTHOR]

This paper raises some issues about understanding religion, religions and spirituality in health care to enable a more critical mutual engagement and dialogue to take place between health care institutions and religious communities and believers. Understanding religions and religious people is a complex, interesting matter. Taking into account the whole reality of religion and spirituality is not just about meeting specific needs, nor of trying to ensure that religious people abandon their distinctive beliefs and insights when they engage with health care institutions and policies. Members of religious groups and communities form an integral part of the structure and fabric of health care delivery, whether as users or in delivery capacities. Religion is both facilitator and resistor, friend and critic, for health care institutions, providers and workers. [ABSTRACT FROM AUTHOR]

Purpose – This case study seeks to explore the differences between carer and professional perspectives in the assessment and treatment of a young man with intellectual disabilities, autism and mental health problems. Design/methodology/approach – The opinions and perspectives of psychiatrists involved in the care and treatment of "S" and "S"'s mother about the aetiology, course, treatment and prognosis of "S"'s condition, are explored using "explanatory models". Findings – This paper shows the similarities and the differences of opinions and perspectives about the mental health care of a person with intellectual disabilities. Originality/value – It shows how the explicit comparison of notions about a person's condition, assessment and treatment may help all involved to work together for the common ground of achieving the best outcomes for service users. [ABSTRACT FROM AUTHOR]

Purpose – The paper aims to investigate the collective behaviour of boards of directors in 22 English National Health Service trusts and how this impacts on the exercise of their role and functions. Furthermore, it aims to shed light on the governance model characterising boards of health sector organisations. Design/methodology/approach – The data were gathered using a range of qualitative techniques (96 semi-structured interviews, focus groups, workshops and document analysis) with a multiple case study approach. Findings – Owing to the existence of overlapping governance ideologies, health care boards are characterised by different internal dynamics, processes and levels of engagement in the exercise of their tasks. Post-new public managment driven boards emphasise a pronounced collective approach in their internal proceedings, a wider perspective in strategising and a greater stakeholder involvement in decision-making processes. These characteristics are particularly evident in boards of foundation trusts, in which network driven governance principles and mechanisms receive a more comprehensive implementation through a collective leadership approach. Practical implications – The model of the board shared by foundation trusts moves these health care organisations closer to the idea of social enterprises. Additionally, the evidence shows similar behavioural characteristics between these boards and the best practice examples of private sector boards. Originality/value – The foundation trust model of the board provides new meaningful connotations and significance to the traditional understanding of health care boards, offering a more comprehensive notion of their role and functions in terms of leadership provision, strategy formulation, monitoring and reporting. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to outline the process of undertaking the Confidential Inquiry (CI) into the deaths of people with learning disabilities and discusses three particular issues: engaging with professionals; maintaining confidentiality; and the tension between wanting to base the findings on a sufficiently large number of cases so that the findings are robust and reliable, but also wanting to make immediate changes to any potentially modifiable factors found to contribute to the deaths of people with learning disabilities.Design/methodology/approach - The CI into the deaths of people with learning disabilities reviews the deaths of all people with learning disabilities living in the (former) Avon and Gloucestershire areas. It has been commissioned by the Department of Health to run until March 2013. One of the key drivers for a CI has been the work of Mencap in exposing the unequal health care that some people with learning disabilities received in the NHS.Findings - The principal goal of the CI is to improve the standard and quality of care for people with learning disabilities and ultimately their health outcomes. The CI team aims to detect potentially modifiable contributory factors in the care of a person with learning disabilities who has subsequently died, share any examples of good practice in their care and provide information to guide the commissioning of services.Originality/value - It is anticipated that the findings of the CI will provide a considerable amount of evidence on which to improve the standard and quality of care for people with learning disabilities and ultimately their health outcomes. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to develop a conceptual resilience-based model that takes account of the competing success factors of patient safety, finance, improvement targets and staff workload in NHS hospitals in the UK. Design/methodology/approach – A safe working envelope model was developed from the literature and adapted for use in the NHS. The proposition that finance and targets receive greater management attention was then tested by a pilot study using content analysis of risk management documents of four NHS hospitals. Findings – The need to succeed on finance and targets received greater attention in the risk management documents than patient safety and staff workload. Research limitations/implications – This is a pilot study only, using content analysis of risk management documents from four hospitals to see whether the model developed from the literature warrants further study. Practical implications – Using the proposed safe working model will allow the setting and monitoring of failure and marginal boundaries and make more explicit the pressures from the competing success factors in public sector hospitals in the UK. Originality/value – The development of the conceptual model using ideas from resilience engineering and applying them to NHS hospital management provides a policy and practical approach to improving patient safety. [ABSTRACT FROM AUTHOR]

Solidarity is widely described as one of the leading principles for the public provision of health care in Western Europe and is therefore prominently discussed in debates on the introduction of genetic technologies in national health care provision arrangements. However, solidarity is often defined in an essentialist and quantitative way, which does very little to show the complexities of and changes in health care allocation. In this paper we therefore propose to analyze solidarity as a value that is reproduced in practices of providing health care. This means that we analyzed how three particular genetic technologies are incorporated in basic health care provision in Germany, the Netherlands and the United Kingdom and how individuals or groups at risk get access to them. On the basis of a characterization of the distributive mechanisms in these three countries, we argue for a discussion on genetics and solidarity that pays attention to the complexity and specificity of practices in the analysis and politics of solidarity. [ABSTRACT FROM AUTHOR]