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An editorial is presented on the possible implications of personalization for adult care social workers. It outlines the considerable relevance for social work for the foreseeable future. An overview of the how similar personalization policy agendas in England and the Italian region of Lombardy are translated into practice is presented.

'Complexity' is theorised as a characteristic of modern food systems that poses a challenge to improving population diets. This paper seeks to explore the discursive deployment of 'complexity' in the context of public health. Doing so helps inform a more critical assessment of commercial and political determinants of health, and of 'complexity' as a prevailing frame for public health issues. Qualitative methods were used to explore 'responsibility' for healthy eating in the food system in the United Kingdom. Discourse analysis was conducted on corporate and government documents, and interviews with industry and government stakeholders. The aim was to examine the implications of 'complexity' within discourses of dietary public health. 'Complexity' was used not only to characterise dietary public health problems but also as a rhetorical device in public health narratives. It performed two main discursive functions: firstly, to represent diet-health problems as so multi-layered and difficult that they are intractable. Secondly, and despite this acknowledged complexity, to deflect from food system actions for improving diet to 'simpler' and non-food interventions, by industry and government. These uses of 'complexity' serve to attribute primary responsibility to individuals for dietary choice and to obscure inaction by government and industry, who have most control over the determinants of those choices. In short, 'complexity' can be used discursively to generate a smokescreen masking policy inaction in addressing public health problems. [ABSTRACT FROM AUTHOR]

Global health donors increasingly embrace international non-governmental organisations (INGOs) as partners, often relying on them to conduct political advocacy in recipient countries, especially in controversial policy domains like reproductive health. Although INGOs are the primary recipients of donor funding, they are expected to work through national affiliates or counterparts to enable 'locally-led' change. Using prospective policy analysis and ethnographic evidence, this paper examines how donor-funded INGOs have influenced the restrictive policy environments for safe abortion and family planning in South Sudan and Malawi. While external actors themselves emphasise the technical nature of their involvement, the paper analyses them as instrumental political actors who strategically broker alliances and resources to shape policy, often working 'behind the scenes' to manage the challenging circumstances they operate under. Consequently, their agency and power are hidden through various practices of effacement or concealment. These practices may be necessary to rationalise the tensions inherent in delivering a global programme with the goal of inducing locally-led change in a highly controversial policy domain, but they also risk inciting suspicion and foreign-national tensions. [ABSTRACT FROM AUTHOR]

Talking about death and dying is promoted in UK health policy and practice, from a perception that to do so encourages people to plan for their end of life and so increase their likelihood of experiencing a good death. This encouragement occurs alongside a belief that members of the public are reluctant to talk about death, although surveys suggest this is not the case. This paper describes findings from a research study in which people participated in deliberative discussion groups during which they talked about a range of topics related to death, including talking about death, the good death, choice and planning and compassionate communities. Here we report what they had to say in relation to talking about death and dying. We identified three themes: 1. The difference between talking about death as an abstract concept and confronting the certainty of death, 2. how death and dying presents issues for planning and responsibility, and 3. approaches to normalising death within society. For our participants, planning was considered most appropriate in relation to wills and funerals, while dying was considered too unpredictable to be easy to plan for; they had complex ideas about the value of talking about death and dying. [ABSTRACT FROM AUTHOR]

This paper presents an overview of the importance of mental health services for unaccompanied asylum-seeking children in the United Kingdom. It reviews what mental health support appears to be available in the United Kingdom following an on-line search which took place in Spring 2021 and using information gathered through 22 interviews and focus groups with stakeholders. The latter group are defined as people working with asylum-seeking children. The primary stakeholders were local authority staff, although interviews were also conducted with local government associations (London Councils, the Local Government Association), NHS bodies and the voluntary sector. Often, further relevant stakeholders were identified during interviews. The report details the aims, methodology and context, before the findings are presented which is followed by recommendations for improving mental and social care provision for unaccompanied asylum-seeking children in the United Kingdom. [ABSTRACT FROM AUTHOR]

Contribution analysis (CA) is being increasingly favoured as a policy evaluation tool. This includes application to evaluate alcohol and drug policies. This paper reflects on one such example and begins by providing a brief overview of CA as an evaluative research method. It then describes the way in which CA was applied to evaluate alcohol and drug policy in Wales, one of the constituent countries of the UK. This paper reports on two issues. First, how the theory of CA was translated into practice. Second, the key learning points for us as evaluators that arose out of the utilisation of this method. The article highlights that our use of CA enabled a rich exploration of programmes within their contextual setting, and had a range of limitations and considerable challenges associated with identifying and explaining causalities. Within these methodological discussions, we also illustrate how the policy was more successful in elements closer to its nomenclature framing; i.e. harm reduction, than it was to other incorporated aims. The analysis presented in this paper will be useful across a range of jurisdictions where the need to evaluate drug and alcohol policy and practice initiatives may arise. [ABSTRACT FROM AUTHOR]

As obesity constitutes a growing health concern over the world, it has also become an important part of public policy agendas. This paper critically analyses the development of the policy debate and measures around obesity in the UK. The paper contributes to the debate by challenging the current individualized nature of nudge policies as the most popular application of behavioural economics to policy. We argue that it may be possible to change the choice architecture of individuals through nudge, but the overall effectiveness of such policies would be limited because the broader social, economic and political architecture shaping individual choices is ignored. The case of the UK provides a good illustration where concrete policy measures are predominantly focused on choice despite growing recognition of the structural determinants of obesity, and the governments are thus able to avoid threatening free markets and existing economic interests. Whilst the recently introduced sugar tax constitutes a certain shift in policy, it clearly remains an exception within the whole policy package. [ABSTRACT FROM AUTHOR]

This paper examines the impact of major social security reform on mental health claimants by analysing the transition to Personal Independence Payment in the UK. Personal Independence Payment was introduced in April 2013, replacing Disability Living Allowance as the main non-means tested disability benefit intended to assist with the additional costs associated with disability or long-term health conditions. It is important to gain a better understanding of how people with mental health problems have experienced this reform. Twelve service users were interviewed for this qualitative research. Analysis identified three main themes: problems with the Personal Independence Payment claims process; problems conveying mental health problems during the assessment process; and positive experiences associated with the transition to Personal Independence Payment. This research demonstrates that major changes in benefit policy are challenging for people with mental health problems, particularly when delivered in a climate of austerity. The UK Government has changed the main disability benefit for disabled adults. From April 2013, Disability Living Allowance (DLA) has been phased out and replaced by Personal Independence Payment (PIP). This research found that this significant change caused difficulties for people with mental health problems. Everyone who took part reported increased anxiety, problems with claiming PIP, communicating with benefit officials and the medical assessment. It is important to learn from these problems so that future benefit changes, both in the UK and in other countries, can be developed and rolled-out in ways which are more appropriate for people with mental health problems. [ABSTRACT FROM AUTHOR]

While the COVID-19 pandemic now affects the entire world, countries have had diverse responses. Some responded faster than others, with considerable variations in strategy. After securing border control, primary health care approaches (public health and primary care) attempt to mitigate spread through public education to reduce person-to-person contact (hygiene and physical distancing measures, lockdown procedures), triaging of cases by severity, COVID-19 testing, and contact-tracing. An international survey of primary care experts' perspectives about their country's national responseswas conducted April to early May 2020. This mixed method paper reports on whether they perceived that their country's decision-making and pandemic response was primarily driven by medical facts, economic models, or political ideals; initially intended to develop herd immunity or flatten the curve, and the level of decision-making authority (federal, state, regional). Correlations with country-level death rates and implications of political forces and processes in shaping a country's pandemic response are presented and discussed, informed by our data and by the literature. The intersection of political decision-making, public health/primary care policies and economic strategies is analysed to explore implications of COVID-19's impact on countries with different levels of social and economic development. [ABSTRACT FROM AUTHOR]

Reports in the British media over the last 4 years have highlighted the schisms and contestations that have accompanied the reports of gender selective abortions amongst British Asian families. The position that sex-selection may be within the terms of the 1967 Abortion Act has particularly sparked controversy amongst abortion campaigners and politicians but equally among medical practitioners and the British Pregnancy Advisory Service who have hitherto tended to stay clear of such debates. In what ways has the controversy around gender-based abortion led to new framings of the entitlement to service provision and new ways of thinking about evidence in the context of reproductive rights? We reflect on these issues drawing on critiques of what constitutes best evidence, contested notions of reproductive rights and reproductive governance, comparative work in India and China as well as our involvement with different groups of campaigners including British South Asian NGOs. The aim of the paper is to situate the medical and legal provision of abortion services in Britain within current discursive practices around gender equality, ethnicity, reproductive autonomy, probable and plausible evidence, and policies of health reform. [ABSTRACT FROM AUTHOR]

Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor. [ABSTRACT FROM AUTHOR]

This paper discusses state-medicine relations in Canada and Britain as an expression of medicine's perceived dominance of the health policy field. The two main questions addressed by the paper are: how do institutional frameworks affect the outcome of state-medicine conflicts, and how does the medical profession react to challenges to its policy monopoly? These questions are considered in two instances where determined state actors enacted legislation in the face of widespread and vocal medical opposition: the 1984 Canada Health Act and the 1990 NHS and Community Care Act. Contrary to much of the literature on professional dominance this paper highlights the predominant role of the state in the state-medicine nexus and shows the conditional and ephemeral nature of medicine's policy monopoly and this monopoly's reliance on a co-operative and acquiescent state actor. The paper further shows that institutional factors, such as centralisation, do not offer a greater opportunity for the solidification of the medical policy monopoly. [ABSTRACT FROM AUTHOR]

The article focuses on the debate on the White Paper, "The New NHS--Modern--Dependable" which bears the hallmarks of pragmatism which have characterized many of the Labour Government's initiatives in Great Britain. The National Health Service (NHS) presented Prime Minister Tony Blair's government with a considerable challenge. Labour in opposition had opposed the Conservative Government's health reforms and continued to campaign against bureaucracy and yet some aspects of the reforms seemed to work. Labour had opposed GP fundholding because it seemed to increase inequity, and yet fundholding had been adopted by many doctors and more than half of the population were served by fundholding practices. Labour had promised improvements in the NHS and yet had accepted tough public spending limits. The White Paper seems to have steered the new Government through the first and second of the challenges, the third will only be addressed if the NHS is a clear winner in the Comprehensive Spending Review. The dilemma of the Conservative health reforms is tackled head on by declaring that what counts is what works. The White Paper retains many of the key features of the previous Government's reforms.

Organ donation is constructed in the UK as a public responsibility, but more particularly as an obligation for members of minority ethnic communities. This paper draws attention to the ways in which ‘ethnicity’ has been made problematic by the allocation practices of transplant medicine, health promotion discourses and policy developments. Taken together, they have served to culturalise and racialise the procurement of organs. As the problem of organ donation is as much made inside medicine as outside it, this paper argues greater attention ought to be paid to these institutional practices and processes. Drawing on ethnographic work in the north of England, and with a specific focus on the organ consent encounter, this paper shows how categories of ethnicity in organ transplantation are an outcome of biopolitical and institutional practices. It argues that organ donation is best thought of, less as a discrete temporally-bounded act of decision-making, and more as a set of variegated situated practices that, in all manner of ways, problematically produce the publics that transplant medicine has come to rely upon so profoundly. [ABSTRACT FROM PUBLISHER]

Symptoms of depression are common in adolescents and have negative impacts on academic engagement and achievement, as well as on future mental health and functioning. A number of psychological therapies are effective for the treatment of adolescent depression but there are barriers to young people accessing treatment promptly. Providing treatment in school may help improve access to mental health care; school-based mental health care is routinely provided in some parts of the world and is currently a policy priority in the UK. However, introducing mental health services into schools will require services to adapt. This paper illustrates how a short-term psychological therapy can be delivered successfully in schools. It describes the treatment and outcomes for two young people with symptoms of depression. Both received Brief Behavioural Activation (Brief BA) which has been adapted specifically for adolescents. Brief BA focuses on helping young people engage with valued activities in different areas of their life, thus increasing rewards and reducing symptoms of depression. The two cases highlight a range of educational and clinical benefits of Brief BA for young people with depression symptoms and illustrate how the treatment and service delivery were adapted for schools. [ABSTRACT FROM AUTHOR]

This paper examines the multiple ways in which health policy relating to obesity, diet and exercise is recontextualised and mediated by teachers and pupils in the context of social class in the UK. Drawing on a case study of a middle-class primary school in central England, the paper documents the complexity of the policy process, its uncertainty, its intended and unintended affects and effects on the lives and bodies of young people as they negotiate ‘health’ across a range of social contexts. Particular attention is paid to the voices of young people, whom by way of embodying imperatives found in health discourses become ‘troubled bodies’, ‘emboldened bodies’, or ‘insouciant bodies’, as such imperatives intersect with pupils' various subjectivities. It is argued that whilst all pupils appear to be affected by health policy, they are differently effected by it. The paper will outline how pupils were effected by health policy in emboldened and privileged ways and how the young people seem to not only remain unscathed by health imperatives but are also positively emboldened and privileged by them. This paper adds to understandings of social class and relationships between public health discourse and individual (e.g. pupil) subjectivity, and highlights both the complexity of the policy process itself as a product of the organisational and social relations of schooling, as well as the complex and idiosyncratic nature of young people's embodied subjectivities. [ABSTRACT FROM AUTHOR]

This paper considers the impact of a culture of performance management on the UK drug strategies since 1995. It discusses the background to the emergence of this policy direction and explores the reality of the culture through interviews with those responsible for making and implementing drug policy. Within the UK drug policy has been made centrally, but is implemented at a local government level and this is an important feature. The paper considers the interaction of performance management with other policy features, such as devolved power, New Labour, regionalization, partnership, and an emphasis on evidencing implementation. The findings indicate that the performance management of the strategies by the centre has developed and increased over time, but that this is perceived as a necessary evil; without it the drug strategy would not be so well understood or supported at the centre. Thus, the implication is that drug services would not have been so well funded and drug treatment would not have improved. [ABSTRACT FROM AUTHOR]

A variety of new non-professional roles, such as health trainers and community food workers, have evolved from recent UK public health policy developments. These roles predominantly operate in communities characterised by extreme social deprivation. Their remit is to offer local people support to help change lifestyle 'choices', for example, healthy eating or drinking responsibly. However, encouraging people to change health-related behaviour often ignores the underlying social determinants of health related behaviour. Health trainers and community food workers have been identified as being able to bridge the gap between the health professional and lay person, because of their ability to identify with local people. The challenges faced by these non-professionals, working at the coal-face of communities, and in a new and evolving role, are as yet poorly understood and this paper details the mechanism of reflective learning adopted by these practitioners in order to explore the professional practices involved. Emergent issues faced by these new practitioners include: understanding the boundaries between the trainer role and other health services; and the issues raised by the community, for example, presenting with non-health reasons such as financial crisis, which the trainers were often unprepared to deal with, rather than 'lack of health skills' (e.g. cooking skills). This paper explores how reflective learning processes can deconstruct the experiences of this 'new level of the health workforce' who have on the one hand the sensibility and sensitivity to develop relationships with individuals and households in poorer communities, yet are ill equipped to deal with the wider structural factors often determining behaviour. [ABSTRACT FROM AUTHOR]

Despite an increasing number of policies and guidelines relating to psychological therapies within the NHS, there is little clear evidence of many of the intended benefits actually accruing from their implementation. Drawing on the work of Tom Main and others, this paper examines some of the emotional and unconscious factors, in both staff and patients, which determine the fate of policies and specifically the extent to which they become authentically embedded within a hospital system. Unanticipated or unintended effects of past policy implementation in relation to borderline personality disorder are discussed in the context of secondary and tertiary level NHS psychotherapy services. These effects include the risk that the latter services become sidelined by cheaper initiatives and interventions at primary care level, irrespective of the evidence base in relation to borderline personality disorder. Given the financial and human costs of policy failure, the paper proposes a significant and active role for psychodynamic psychotherapists in promoting a more thoughtful approach to local policy implementation so as to lead toward a service that is genuinely patient-centred. [ABSTRACT FROM AUTHOR]

In this brief paper, I argue that the coronavirus pandemic is functioning like an ethnomethodological 'breaching experiment'. In short, it is putting a gigantic spanner in the works of neoliberal governance, in the process exposing the widening cracks and fissures of what I have called the 'fractured society'. I begin by recalling Garfinkel's notion of the breaching experiment and by listing the principal attributes of the fractured society. I then explore the response to the coronavirus in the UK, from the government's initial commitment to 'herd immunity' to its present policy of 'muddling through'. The bulk of the remainder of this contribution addresses precisely how this global health crisis shines a harsh and unforgiving searchlight on the strategies and policies pursued by governments in the UK since 2010, and most especially after the passing of the Health and Social Care Act of 2012. In the closing paragraphs, I examine possible scenarios for a post-fractured society, making particular use of Fraser's concepts on 'reactionary' versus 'progressive populism', and conclude with a comment on sociology and engagement. [ABSTRACT FROM AUTHOR]

Aim: This paper explores wound care for people living with mental health difficulties from a nursing perspective and considers what can be done to improve it. Objective: To analyze policy and practice relating to wound care for people experiencing mental ill health using the ideas of 'wicked problems' and 'problems of many hands' Methods: Policy and practice analysis informed by theory. Results: Recent UK policy is to ensure parity of esteem so that people with mental ill-health receive the same quality of care as those with physical ill-health. However, the provision of physical care to people experiencing mental ill health, including the provision of wound care, constitutes a 'problem of many hands' arising in the context of the mental health system being a complex one replete with wicked problems. Wicked problems are resistant to solutions and problems of many hands are complex and multifaceted, and involve the interplay of different actors. Addressing problems of many hands in this context requires systems thinking and solutions enabling different people to work collaboratively. Conclusions: The wound care of people experiencing mental ill health has been largely overlooked, as it transcends the domains of mental health and tissue viability policy and practice. A strong system level approach is needed to improve care, characterized by closer interprofessional teamworking. The wound care of people experiencing mental ill-health is largely overlooked. People with mental illness receive their wound care from tissue viability nurses. Wound care can be conceptualized as a 'problem of many hands'. System level policies are needed to improve this aspect of health care. [ABSTRACT FROM AUTHOR]

This paper analyses the newly proposed United Kingdom (UK) psychiatric diagnosis of ‘dangerous and severe personality disorder’ (‘DSPD’). The aim is to show how the category of ‘DSPD’ manifests aspects of Beck's analysis of the ‘risk society’ and poststructural ‘governmentality’ approaches to understanding the notion of risk. Concepts such as ‘dangerousness’, ‘violence’ and ‘risk’ are critically reviewed in relation to ‘DSPD’ and are found to be less than objective. The paper interrogates the political underpinnings of this newly proposed diagnosis and analyses pre-existing frameworks of potential utility for developing further understanding of dangerousness and violent behaviour. Key issues are critically discussed in relation to the concept of ‘dangerousness’ including the reliability of assessment tools, the socioeconomic status of those potentially diagnosed with DSPD and detention without committing any prior offence. The paper also discusses the potential for conflict between the proposed legislation, the UK Human Rights Act 1998, healthcare practice and the likelihood of divided professional loyalties. The paper argues that this newly proposed public health policy has a sociopolitical rather than psychiatric rationale for justifying psychiatric detention and, as such, is a psychiatric manifestation of the late modern culture of risk. [ABSTRACT FROM AUTHOR]

Based on a detailed reading of the six preceding papers, in conjunction with a reflection on the socio-political forces shaping lifestyles in the UK at the turn of the millennium, we come to four interrelated conclusions. First, sport and exercise science needs to move beyond evidence-based practice to evidence-based policy. Second, sport and exercise science needs to make health-enhancing physical activity a political issue at both national and local level. Third, transport, not health policy, may be the key to promoting health-enhancing physical activity. And, fourth, young people deserve our special attention. In reaching these four interrelated conclusions, we attempt both to shape evidence based policy and future research agendas in exercise science. To achieve an international perspective, we also present a short case note from Australia. [ABSTRACT FROM AUTHOR]

Comments on various issues concerning public health in Great Britain. Challenges in building multidisciplinary public health; Concerns over health policy agendas in Great Britain; Significance of partnership for making public health to work effectively within current structures.

This conceptual paper is written from the perspective of two qualified and registered social workers who are former supervisors/managers in both statutory and voluntary children’s services. Now as social work academics, the authors of this paper consider the British Association of Social Workers (BASW) supervision policy in the context of current debates about social work and supervision in child protection practice. Whilst optimistic about the intensions of BASW, we explore the social and political landscape in which the BASW policy has been developed and give consideration to the tensions faced by a profession seeking to reclaim a defining feature of professional social work. Using Kadushin’s model of supervision where the functions of supervision are outlined as three primary domains: educational, administrative and supportive, this paper will examine the interconnectedness of these elements and their relevance in the debates and policies that have focussed on the event that is supervision in social work in the UK. This paper will also introduce a critical challenge that seeks to refocus attention to the nature of the relationships involved in carrying out the task of supervision in the environment in which child protection social work is practised. [ABSTRACT FROM PUBLISHER]

During the latter part of the 1980s registered nurse education was transferred from hospital-based training to higher education in Australia and the UK. Examining this transfer process, analytical attention is focused on the contrast in subsequent funding arrangements for registered nurse education between the two nations. It is argued that the difference in funding arrangements can be explained by an analysis of two separate movements impacting on health care policy in both Australia and the UK: those of professionalisation in nursing and economic rationalisation. This paper discusses the implications of these movements and the subsequent differing educational funding arrangements in terms of the professionalisation of nursing in Australia and the UK. [ABSTRACT FROM AUTHOR]

The growing use of psychoactive substances in everyday life, the increasing experimentation among users and the potential of poly drug use for non-medical, lifestyle or enhancement purposes presents an evolving policy challenge. The paper aims to build on previous research to gain a more in-depth qualitative understanding of the imaginaries around pharmaceutical cognitive enhancement (PCE). It focuses in particular on how the so-called pharmaceutical cognitive enhancing drugs (PCEDs) might be used and the social acceptability of these uses across multiple social contexts and groups. Data come from 23 focus groups (99 participants), representing a wide range of social groups, recruited in the UK. We discuss four distinct 'enhancement practices' where PCE use was conceptualised as a way to (1) become the best version of oneself; (2) gain a competitive edge over others; (3) for personal achievement or well-being; and (4) promote personal/public safety. The findings problematise the term 'enhancement' by showing the different ways in which the use of pharmaceutical 'enhancement' drugs can be imagined and understood. We argue for the value of policy responses that acknowledge and respond to a wider range of enhancement practices including those of prospective user groups. [ABSTRACT FROM AUTHOR]

Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics. [ABSTRACT FROM PUBLISHER]

This paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern. [ABSTRACT FROM AUTHOR]

Professional sports clubs (PSCs) are potentially effective settings for health promotion; however, their role within policy is unclear. Potential reasons include lack of awareness about existing provision of health and wellbeing (H&W) programmes and adequacy of monitoring and evaluation (M&E) practices. This review aimed to: (i) map the provision of H&W programmes delivered by PSCs in the United Kingdom (UK), and (ii) explore current M&E practices of PSCs and consider the policy implications of this. Websites from eight professional sport leagues were hand-searched for programmes and impact reports. Suitable programmes were quantified, whilst impact reports were analysed via inductive documentary content analysis. Results identified 176 H&W programmes and 36 impact reports, as well as 43 H&W impact statements, but only 14 of these were aligned to specific H&W outcomes. The H&W aims of programmes were typically vague, measurement tools were rarely used, and evaluations were usually anecdotal case studies and based on engagement figures, which may not only limit the potential uptake of these programmes but also the relevance of PSCs to public policy. Further research is thus needed to build a stronger evidence base for the use of PSCs as vehicles of public health promotion and policy, and to better address the challenges faced when seeking to monitor and evaluate PSC programmes effectively. [ABSTRACT FROM AUTHOR]

This paper documents how health is storied into existence by 'obesity discourse' to become part of the 'natural attitude' towards the health of individuals or populations. We draw attention to some of the major policy documentation influencing thinking on 'health' and school health education in the UK over recent years, especially, every child matters (ECM) and subsequent, related measures, for example the National Healthy Schools Programme (NHSP). We suggest that these measures have helped shape and make a 'totally pedagogised society' and 'totally pedagogised schools' in which 'health', reduced to an issue of weight, exercise and diet, becomes everyone's concern, everywhere. The analyses highlight the socio-political and psychological leanings of such policy documentation and its potential effect on the identities of children and young people when institutionalised and 'authorised' through state policies and the body pedagogies of schools and multiple other agencies. [ABSTRACT FROM AUTHOR]

Risk assessment studies often adopt a quantitative approach and analyse decisions or judgements in relation to risk at one specific point in time. These studies certainly have their merits but their preponderance in the literature on risk has been to the exclusion of qualitative studies that seek to examine judgements of subjects over an extended period of time. I seek to redress this imbalance by examining how scientists assessed risk in the context of a significant public health problem in the UK: the emergence of bovine spongiform encephalopathy (BSE) in cattle. This disease first emerged in British cattle in 1986. Yet over 20 years on, its implications for human health are still being assessed by scientists. In this paper, I examine the reasoning strategies that scientists employed to make risk assessments in relation to BSE in the period between 1986 and 1996. Two arguments in particular (analogical argument and the argument from ignorance) were the mainstay of scientific reasoning in the period under investigation. The rational standing of these arguments varied over time in relation to evidence that was emerging from experimental and other studies. It is argued that it is not possible to capture the factors which are necessary to understanding scientific risk assessments in relation to BSE within the type of quantitative, static study that is typically pursued within research on risk. [ABSTRACT FROM AUTHOR]

This paper reviews four major topics related to the long-term psychosocial rehabilitation for burn survivors; (1) Body image adjustment process; (2) Social functioning challenges; (3) Interventions designed to address psychosocial rehabilitation challenges; and (4) Current policy developments in the USA and the UK that focus on raising the rehabilitation standards for psychosocial care for burn survivors. While acknowledging the close relationship between body image distress and social functioning, these two areas are reviewed separately with the goal of addressing two specific questions. First, what does current empirical research and clinical experience teach us about each of these areas, and second, what are the most important gaps in current knowledge about body image and social functioning, respectively? The final section of the paper specifically addresses the question of what can be done, from a practical and a health policy perspective, to ensure that existing body image and social difficulties are appropriately addressed. [ABSTRACT FROM AUTHOR]

After many years of debate and controversy, a decisive step in the regulation of health professionals in the UK was taken when Trust, Assurance and Safety — The Regulation of Health Professionals in the 21st Centurywas published in 2007. This white paper sets out new proposals to ensure that all statutorily regulated health professionals periodically revalidate their professional registration. Through this mechanism of revalidation, health professionals are to demonstrate their continued fitness to practise. Under the proposals, medical revalidation will have two components: relicensure and specialist recertification. For relicensure, all doctors will have a licence to practise that enables them to remain on the medical register, and this licence must be renewed every five years. This process will be managed by the General Medical Council (GMC). Recertification will apply to all specialist doctors, including general practitioners, requiring them to demonstrate that they meet the standards that apply to their particular medical specialty. These standards will be set and monitored by the Medical Royal Colleges and the specialist societies, and approved by the GMC. Recertification will take place every five years and, where possible, will coincide with relicensure. This paper sets out the approach of the Royal College of Obstetricians and Gynaecologists to setting standards for the recertification of obstetricians and gynaecologists. [ABSTRACT FROM AUTHOR]

This paper critically examines the public policy environment that underpins the politics of health promotion in England. English health policy from the late 1970s to the mid 1990s was not receptive to health promotion. The new Labour government elected in 1997 claimed to embrace a 'Third Way' between the free market and socialism that would appear to embrace a community-centred approach to health promotion that would through partnership-building promote equity; perversely, however, the election of this government rhetorically committed to healthy public policy was accompanied by a crisis in health promotion delivery. Despite apparent commonalities between the Third Way and health promotion, the Third Way was in many respects a neoliberal ideology and so has contributed to the marginalisation of health promotion. Although some might argue that health promotion has been mainstreamed, it is argued here that in terms of the crucial National Health Service infrastructure underpinning the health promotion movement, that the organisational capacity for health promotion has been significantly weakened. Thus the question is how you revive a movement that has lost its way? The answer must include taking a historically informed approach to analysing the problem and identifying solutions. Wider systems issues in England include the emergence of multidisciplinary public health, the sequence of changes to national health promotion organisations and the wider marginalisation of the public health movement. It is only by critically analysing and addressing these systemic issues that the prospects for health promotion in England can be revived. [ABSTRACT FROM AUTHOR]

There is a widespread academic and policy debate about public responses to precaution in public health campaigns. This paper explores these issues in relation to the precautionary stance adopted in the UK around the regulation of mobile telecommunications. The aim of the paper is to examine the nature of attitudes to precaution, and the way in which these, along with other relevant variables, relate to the intention to adopt relevant behaviours. The results from an experimental study (n = 173) indicate that people distinguish between two dimensions of precaution: firstly in relation to its value or necessity per se and secondly as anchored to notions of governance. The two variables differentially relate to other variables including trust and uncertainty, and are predictive of intended behaviour change indirectly, through worry about mobile phone risks. Precautionary advice was generally interpreted as causing concern rather than providing reassurance. The results suggest that precaution may be considered a valuable stance but this does not mean that it is seen as good governance or that it will reduce concern. Whilst the discourse of precaution is aimed at reducing concern, it appears that the uptake of relevant behaviours is largely triggered by worry. [ABSTRACT FROM AUTHOR]

Risk is a central defining feature and area of concern in adult social care provision, but what do we actually know about how service users, carers and practitioners define and manage risk? This question is increasingly important as current policy advocates greater service user choice and control through a range of self-directed support mechanisms, and statutory duties and professional boundaries are challenged. This paper reports the results of a recently completed UK based scoping review that investigated how different groups of adult social care service users and service providers perceive and understand the everyday risks they face. It highlights how different management strategies are also adopted by different groups of people, which can lead to tensions and potential conflict between practitioners, service users and informal carers. However, whilst some areas of risk in adult social care have been the focus of considerable research, others appear to have been largely ignored. The voices of some groups of users remain hidden and apparently of little concern. These gaps and inconsistencies will be identified and discussed in relation to current policy developments and their implications. [ABSTRACT FROM AUTHOR]

The role of the independent sector in the provision of clinical services on behalf of the NHS in England is often misunderstood and is perceived by some stakeholders as offering the NHS little more than marginal additional capacity. Indeed, some NHS organisations have been accused of 'obstructive, disruptive and protectionist behaviours' towards non-traditional 'NHS family' service providers. This paper outlines the development of the independent sector's role in the provision of clinical healthcare services over recent years. The first part of the paper considers the historical context, including the impact of both the changing role of the state over the past 50 years and the change of government at the end of the last century. Consideration is then given as to the position today, and the impact of current policy drivers for the use of the independent sector in the provision of NHS clinical services. The final part of the paper uses the specialty of orthopaedics, for the purposes of illustration, in order to explore the contribution of the independent sector to the delivery of the last remaining major access target, 18 weeks referral to treatment, and the development of a range of responsive services in the community. [ABSTRACT FROM AUTHOR]

The introduction of choice into the NHS has been a major feature of the UK Government's health policy of the past few years. This paper discusses the limits of choice, emphasising the need for clarity between the NHS and independent sector in making treatment available to those patients who choose to pay for it. The financial limit placed on the NHS, however, is one limit to choice that cannot be overcome. This will be more constrained in the future, due to the slowdown in increases in government spending on the NHS. This slowdown signals a policy shift away from individual choice to a more personal type of care through the introduction of 'collective' patient engagement mechanisms, introducing a patient's 'voice' into the development of quality local health services. The paper concludes that how the NHS — and private providers — responds to these challenges will determine whether choice will prove to be a friend or foe. [ABSTRACT FROM AUTHOR]

Attaining quality health care has long been a social policy priority for countries internationally. This discussion considers issues important to understanding quality, and audit implementation in particular. The paper covers, first, the principles and practice of audit and, second, broader implementation issues, which together point to the further development of quality initiatives in health in the United Kingdom health care context. To close, the future of audit as a means of improving health care is elaborated. [ABSTRACT FROM AUTHOR]

This paper applies Jessop's analysis of the new political economy of welfare to the case of the NHS, exploring the insights into the changes in health policy in the UK that such a perspective offers. Alongside Jessop's analysis, the paper also considers the competing tension of path dependency in health policy, and the possibility of alternative futures to those envisaged in Jessop's model. [ABSTRACT FROM AUTHOR]

The aim of this paper is to uncover arguments over rationing health care as outlined in the British broadsheets. Following a brief introduction to the development of rationing in Britain, it considers the role of the media in society and looks at the arguments developed by the right wing media and contrasts these with the perspectives of the center left. It is argued that although these two perspectives have things in common, they differ significantly in the ways they view the social responsibilities of the state and in the way they interpret the health needs of the nation. [ABSTRACT FROM PUBLISHER]

The introduction of Clinical Governance into the National Health Service in England represents a fundamental shift in the regulatory relationship between the state and medical professionals. This paper critically examines the underlying assumptions of Clinical Governance, and discusses them in relation to Foucauldian concepts of 'governmentality'. First, official definitions of Clinical Governance are reviewed in the context of other policies to apply increased control and surveillance to medical professionals and linkages between this and wider tends in public sector managerialism and governance. The paper then briefly considers these developments in relation to theoretical accounts of bureaucracy, professionalism, risk and trust. It is argued that at the organisational level, Clinical Governance can be usefully analysed as involving a move towards 'encoded knowledge' through the use of 'soft bureaucracy'. [ABSTRACT FROM AUTHOR]

While there are important differences between the public health policies of Conservative governments of the 1980s and 90s and the current British Labour government a significant element of continuity is the emphasis on government facilitating informed choice by consumers as a key public health objective. The article considers such approaches to disclosure of health risks with respect to policy on the regulation of smoking. It argues that regulation, in this area, under the Conservatives has not served to ‘empower’ consumers and that such regulatory weaknesses appear to be replicated under its successor. Defects in regulation are traced with respect to disclosure of information on tar and nicotine ‘yields’; and cigarette design with respect to tip ventilation and the use of additives to increase nicotine delivery. It is argued that lack of disclosure and insufficient controls on the industry have led to consumers being misled concerning the relative risks of different types of cigarette. Equally, it is also likely that such deficiencies have enabled manufacturers to represent some cigarette types as ‘safe’. The paper concludes by arguing that, while the weaknesses of the current regulatory regime suggest the need for measures of increased disclosure and control of product design, there is also an unresolved tension as to whether ‘empowerment’ is an intrinsic goal of policy or a means to the achievement of public health targets. [ABSTRACT FROM AUTHOR]

This paper has two central objectives: (1) to examine critically the assumption underlying a central objective of many 'Sport for all' programmes, namely to improve people's health; (2) to illustrate, via the use of two recent British case studies, some of the complexities involved in the administration of sports policy and in coordinating sports policy with health policy. It is argued that almost all the studies which are cited to support the idea that sport is good for health refer not to sport but to physical activity or exercise. But physical activity and sport are not the same. The paper explores some of the key social differences between sport and physical activity—for example the fact that sport is inherently competitive and that many sports are mock battles in which aggression and the use of physical violence are central characteristics—and examines some of the health consequences of these social differences, for example in the terms of the injury risks. It is argued that if 'Sport for all' policies are intended to improve people's health, then more thought should be given to the kinds of physical activities we wish to encourage. The complexity and fragmentation of policy making in relation to sport and the lack of coordination with health policy are illustrated by two case studies: (1) the Sport: Raising the Game policy announced by the Government in 1995 and (2) the implementation within schools of a programme of health-related exercise (HRE) as part of the National Curriculum in Physical Education. [ABSTRACT FROM AUTHOR]

This paper reviews some key issues in risk analysis, management and communication. It concentrates on three areas: communication and choice with regard to clinical risks, risk communication and public health, and the relationship between scientific advice and public policy decisions. In each sphere, some longstanding concerns have recently come to have increased prominence, and the paper briefly reviews some ongoing responses to these. [ABSTRACT FROM AUTHOR]

This paper documents part of a larger qualitative study of the way Health and Safety personnel in one region of the UK view people with mental illness and people with learning difficulties. The paper focusses on Environmental Health Officers' (EHOs) attitudes to mental ill health and their use of language, experiences shaping that use, and consequences for action arising from their understanding and attributed meaning. Findings suggest that the medical model of health and mental ill health is prevalent; that there is still ignorance and stereotypical thinking; and that personal experience (either of self or other) seems to be the best indicator of breadth of thought and knowledge on this topic. Most EHOs saw their own involvement as peripheral and the issue as something to be managed within the employment environment. [ABSTRACT FROM AUTHOR]

The Scottish Government's policy of minimum unit price (MUP) for alcohol has received significant scholarly attention. Much of the focus of this literature has been on the efforts by sections of the alcohol industry to oppose the policy, including attempts to 'frame' key terms of the debate and an understanding of its legitimacy and effects within the wider field of interpretative policy analysis. The present article builds on these studies by re-conceptualizing the MUP debate through the lens of post-structuralist discourse theory and the logics of critical explanation that emerge from this. It argues that the success and failure of MUP (as a projected social logic) can be understood through the shifting coalitions of actors that emerged (political logics) and the affective hold that industry narratives were able to exert (fantasmatic logics) in this context. While focused on UK alcohol policy, the article speaks to a wider research agenda on the 'commercial determinants of health' and, through the application of the critical logics approach, offers new analytical insights beyond those provided by existing models of industry influence. Similarly, it contributes to the field of post-structural policy analysis through its novel focus on the role of commercial entities as health policy actors. [ABSTRACT FROM AUTHOR]

Mental ill health is a universal phenomenon: that is, it is seen across all cultures and societies, even though the presentation may be culture-specific and affected by cultural norms and more. Governments have a moral and ethical duty to develop mental health services which are accessible, appropriate, and non-discriminatory. Equity in funding mental health services is critical. As globally services and their quality vary dramatically, one should be proposing and agreeing on minimum standards of care. In this paper the basic components and minimum standards of care are described. It is imperative that services are non-discriminatory. It is important that governments work with psychiatrists, other mental health professionals, and individuals with mental illness, their families, and carers to plan, develop, and deliver services with adequate funding. Employers and psychological first aid must also be remembered. Services must be geographically accessible. In this endeavour primary care services have a major role to play. Training and clinical decision-making must be part of the change in service delivery. It is imperative that every effort is made to keep the population mentally as well as physically healthy, and people who develop mental illness must have access to evidence-based treatment at the earliest possible opportunity. [ABSTRACT FROM PUBLISHER]