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Background: The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources.Methods: MODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year. Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations.Discussion: Modelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently. [ABSTRACT FROM AUTHOR]

The article focuses on the 4th Interdisciplinary Perspectives on Accounting Conference. Going to Manchester for the Interdisciplinary Perspectives on Accounting Conference is a nice experience. One receives all of the session papers well in advance at home. Papers are not actually presented by the authors themselves. Instead, they are introduced by discussants who summarize and comment on them after which the authors have the opportunity to answer, before the audience is given the chance to participate. In this conference about sixty papers were presented in parallel sessions and thirty in workshops. Five sessions run throughout the conference. Environmental accounting received considerable attention, too. Gender issues were also addressed in such papers as one by Christine Cooper on the deconstruction of sex in accounting, a paper by Sara Reiter on feminist economics, and a paper by Jane Broadbent and Richard Laughlin on the prospect of women's participation in an ideal speech situation within accounting.

This article identifies new arrangements between the state and non-state actors in the public sector, one that extends current understandings of education privatisation, the transformation of public services 'by substitution' and, specifically theories of the 'shadow state'. Drawing on data from the Political Economy of Teacher Education (PETE) project, the paper's context is the current situation of post-qualification teacher development in England and its point of departure the Teaching and Leadership Innovation Fund (TLIF) initiative, in the wider context of Conservative political interests in promoting 'social mobility' through enhancing 'teacher quality'. Through a political economy analysis of public records, course information, Freedom of Information (FOI) requests and interviews, the paper offers an emerging typology of enterprises to describe the organisations that won TLIF funding to provide Continuing Professional Development (CPD) for teachers in designated 'Opportunity Areas'. Further, the paper extends available theorisations of the shadow state by identifying three kinds of shadow state structure – autonomous, intermediate and co-created – in relation to CPD provision under TLIF. This provisional identification is offered for critical examination beyond the immediate context of English CPD policy. The paper argues that these different relations of power and interdependence represent a new political economy of teacher development in England. [ABSTRACT FROM AUTHOR]

Older people in England who pay for social care from their own funds ('self-funders') receive little help in seeking and arranging care compared to older people funded by their local council. This suggests an implicit assumption that people funded by local councils need help to manage their care whereas self-funders do not. This article reports findings from a scoping review of published evidence from England, Scotland and Wales on the skills that older people need, and the help they get, to seek, arrange or manage use of social care, and how this help affects outcomes. Searches undertaken in October 2018 resulted in the inclusion of thirty-six empirical papers and seven reviews. Thematic analysis identified the importance of everyday life and specific business skills, and personal attributes including objectivity when evaluating options. The review identified two significant gaps in the evidence: first, how help in seeking and arranging care compensated for lack of, or complemented existing, skills; and secondly, how outcomes for people receiving help in arranging care compared with those not receiving help. The article concludes that a tailored approach to supporting older people arrange and manage care, irrespective of funding, should be considered. [ABSTRACT FROM AUTHOR]

This is a memoir of the Peasants seminar of the University of London, which ran between January 1972 and February 1989, and to which 208 papers were presented. The following are considered: its origins, the influences which shaped it, and its agenda; the circumstances of its launching; how it gave rise, very directly, to the Journal of Peasant Studies in 1973; its synergy with JPS, especially in the 1970s, and something of its themes, ambience and development. It is concluded that there is no better way of starting and sustaining, in its early phases, a journal than first securing a strong intellectual base, in the shape of a seminar that meets regularly and has a cohesive, but critical, intellectual community. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine trends over time in social care usage and expenditure for adults with learning disabilities in England. Design/methodology/approach: Returns from councils with social services responsibilities in England concerning social care usage and expenditure were analysed to examine the national picture and trends over time for adults with learning disabilities. Findings: In 2017/2018, 147,915 adults with learning disabilities were receiving long-term social care, an increase of 5.7 per cent from 2014/2015. Social care expenditure increased by 10.2 per cent from 2014/2015 to £5.54bn in 2017/2018; adjusted for inflation this was a 2.7 per cent increase. For adults with learning disabilities who receive social care, increasing numbers of people are living with families or in supported accommodation/living, with gradual declines in the number of people living in residential or nursing care. The number of adults with learning disabilities in temporary accommodation is small but increasing. Social implications: While councils appear to be attempting to protect social care for adults with learning disabilities in the face of cuts to council expenditure, social care expenditure and coverage are not keeping pace with likely increases in the number of adults with learning disabilities requiring social care. Originality/value: This paper presents in one place statistics concerning long-term social care for adults with learning disabilities in England. [ABSTRACT FROM AUTHOR]

Drawing on a 2010 analysis of the reform and costs of adult social care commissioned by Downing Street and the UK Department of Health, this paper sets out projected future costs under different reform scenarios, reviews what happened in practice from 2010-19, explores the impact of the growing gap between need and funding, and explores the relationship between future spending and economic growth. In the process, it identifies a 'lost decade' in which policy makers failed to act on the warnings which they received in 2010, draws attention to the disproportionate impact of cuts on older people (compared to services for people of working age) and calls for urgent action before the current system becomes unsustainable. [ABSTRACT FROM AUTHOR]

England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms. [ABSTRACT FROM AUTHOR]

Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers. [ABSTRACT FROM AUTHOR]

Prisons offer policymakers an opportunity to address the pre-existing high prevalence of physical and mental health issues among prisoners. This notion has been widely integrated into international and national prison health policies, including the Healthy Prisons Agenda, which calls for governments to address the health needs of prisoners and safeguard their health entitlement during imprisonment, and the Sustainable Development Goals 2030 concerning reducing inequality among disadvantaged populations. However, the implementation of the austerity policy in the United Kingdom since the re-emergence of the global financial crisis in 2008 has impeded this aspiration. This interdisciplinary paper critically evaluates the impact of austerity on prison health. The aforementioned policy has obstructed prisoners' access to healthcare, exacerbated the degradation of their living conditions, impeded their purposeful activities and subjected them to an increasing level of violence. This paper calls for alternatives to imprisonment, initiating a more informed economic recovery policy, and relying on transnational and national organizations to scrutinize prisoners' entitlement to health. These systemic solutions could act as a springboard for political and policy discussions at national and international forums with regard to improving prisoners' health and simultaneously meeting the aspirations of the Healthy Prisons Agenda and the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Personal health budgets (PHBs) are being promoted in England as expanding the benefits of choice and control to individuals with healthcare needs. National Health Service (NHS) money is provided to eligible people to use as set out in approved care plans, including direct employment of personal assistants (PAs). The government plans to increase NHS‐funded PHBs and to further introduce integrated personal budgets (IPBs). This potentially creates more demand for directly employed or self‐employed PAs with health‐related skills. The objective of this paper is to report findings from interviews with PAs (n = 105) and key informants (n = 26) from across England, undertaken between October 2016 and August 2017, about the potential for the PA workforce to undertake 'health‐related' tasks as facilitated by the introduction of PHBs. PAs were purposefully recruited to ensure the sample included participants from different geographical locations. Key informants were purposefully selected based on their knowledge of policy and community services. Data were analysed quantitatively and qualitatively. This paper focuses on reporting qualitative findings, which are set within the theoretical framework of normalisation process theory to explore implementation challenges of PHBs. The majority (64%) of PAs confirmed that they saw their current roles as congruent with PHBs, were willing to engage with PHBs and undertake health‐related tasks. However, 74% of PAs said they would need additional training if enacting such roles. Key informant interviews appraised the development of PHBs as complex, noting incongruences arising from NHS and social care‐funded PAs carrying out similar roles within different organisational systems. We conclude the current PA workforce is willing to take on PHB work and is likely to interweave this with work funded by PBs and self‐funding care users. Implications include the need for careful consideration of training requirements and delivery for PHB‐funded PAs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to assess the role of local labour market conditions and pupil educational attainment as primary determinants of the post-compulsory schooling decision. Design/methodology/approach: Through the specification of a nested logit model, the restrictive independence of irrelevant alternatives (IIA) assumption inherent in the multinomial logit (MNL) model is relaxed across multiple unordered outcomes. Findings: The analysis shows that the factors influencing schooling decisions differ for males and females. For females, on average, the key drivers of the schooling decision are expected wage returns based on youth educational attainment, attitudes to school and parental aspirations, rather than local labour market conditions. For males, higher local unemployment rates encourage greater investment in education. Originality/value: The contribution of this paper to the existing literature is threefold. First, a nested logit model is proposed as an alternative to a MNL. The former can formally incorporate the structured and sequential decision-making process that youths may engage with in relation to the post-compulsory schooling decision, as well as relaxing the restrictive IIA assumption inherent in the MNL across multiple unordered outcomes, an issue the authors discuss in more detail in the Methodology section below. Second, the analysis is based on extremely rich socio-economic data from the Longitudinal Study of Young People in England, matched to local labour market data and administrative data from the National Pupil Database and Pupil Level Annual School Census, which provide a broad set of unusually high-quality measures of prior attainment. The authors argue that such high-quality data and an appropriate model specification allows identification of the determinants of the post-compulsory decision in a more detailed manner than many previous analyses. Third, the data have the scale necessary to consider whether the determinants of post-compulsory schooling decisions vary by gender, a particularly important issue given the differential education participation rates of males and females (e.g. in this cohort, females are about 10 percentage points more likely to go on to higher education in the UK than males), and the gendered choices of occupation (see, e.g. Bertrand, 2011). The work will, therefore, provide recent empirical evidence from England on gender differences in the determinants of education choices. [ABSTRACT FROM AUTHOR]

This paper considers the origins and traces the history of the Social Fund, an ideologically-motivated social policy departure of the Thatcher era. It identifies the controversy, in research communities amongst others, which surrounded the establishment of the Fund, and considers the evidence of recurring difficulties in its practical operation over a thirty-year period. It then turns to the Coalition administration in Westminster’s decision to divest itself of responsibility for key parts of the Fund, devolving such obligations to local authorities in England, the Parliament in Scotland and the Assembly in Wales. The paper sets out a comparison of the approaches being developed to discharge the Fund’s prior responsibilities in the three nations. It concludes that the essential policy thrust lies in a determination to roll back central state obligations in poverty relief and income maintenance which had hitherto been accepted by all post-war administrations. [ABSTRACT FROM PUBLISHER]

There are many reasons why cities with diverse populations may grow faster. Ethnic diversity might attract human capital, tourists or firms, increase productivity through diverse approaches to problem-solving or ethnic minority entrepreneurship. Yet there are also reasons to believe that diversity could be harmful, by leading to sub-optimal provision of public goods or reducing trust or social capital. Or it may be irrelevant, being merely a proxy for class. A number of studies have shown both positive and negative relationships between diversity and growth, using a range of different measures for ‘diversity’. This paper asks two questions: have more diverse English cities grown faster? And does measurement matter: is it important to have a multinational population or an ethnically diverse one? To answer these questions, in this paper a range of models are estimated for employment growth for 53 English cities between 1981 and 2001. The evidence suggests that cities with a high proportion of their populations born abroad in 1981 grew faster in the subsequent 10 years. Neither diversity by country of birth nor ethnic diversity is significant in the period 1991—2001. However, when variables accounting for both are included together, it appears that cities with a large number of migrants saw higher employment growth in the 1990s, but that ethnically diverse cities were less successful. The results presented here suggest that considerable attention needs to be paid to the variable used to indicate ‘diversity’ in these studies and that the impact of diversity varies according to nature of the groups any indicator for ‘diversity’ is representing. [ABSTRACT FROM PUBLISHER]

This paper examines the connections between American institutionalists and a number of 'non-Marshallian' British economists and social scientists, several of whom were associated with the Fabian Society or the London School of Economics or both. Specifically, the links between institutionalists such as Walton Hamilton and Wesley Mitchell and British social scientists such as John A. Hobson, Henry Clay, R.A. Tawney, William Beveridge and Graham Wallas. It is argued that these connections were related to common views on the importance of institutions, compatible methodological views, common interest in questions of social value, shared policy concerns (particularly unemployment and the coal industry), shared interests in the development of new institutions for education and research in economics and shared connections with the funding activities of the Rockefeller Foundation. These connections were much more extensive than has usually been realized. Some reasons for this British group not to form into a movement similar to American institutionalism are explored. [ABSTRACT FROM AUTHOR]

The City and Hackney Primary Care Psychotherapy Consultation Service is an innovative, public sector service designed to support GPs in meeting the needs of patients with complex psychological/physical health issues throughout the London Boroughs of Hackney and the City. This paper provides an account of how this new model for the National Health Service (NHS) developed in the context of psychotherapy provision within the NHS, within the national and local context in the UK and gives an overview of some the service's key features and how it differs from other services operating in primary and secondary care. A linked paper, in this journal, explores the reality within which the service functions and describes clinical outcomes, health economic data, the modifications to the original model and prospects for the future. [ABSTRACT FROM PUBLISHER]

This paper is a case-study analysis of methylated spirit drinking in England in the 1920s and 1930s, focussing in particular on moral panic about deviant consumption and the development of policy-making. During the interwar years there emerged a statistically minor, but socially significant, culture of drinking methylated spirit - an industrial denatured alcohol - in socio-economically deprived urban communities. In the wake of (often hyperbolic) discourse about the considerable physical damage caused by methylated spirit consumption, and associated concerns about the perceived moral deviancy of drinkers, policy-makers developed a variety of regulatory strategies aimed at curbing consumption. Overall, this paper reveals the complex matrix of legislative, judicial and administrative regulation which framed responses to this widely vilified form of alcohol consumption, and in doing so points to some of the varied pressures and influences which informed harm-reduction policy-making. [ABSTRACT FROM AUTHOR]

In the context of global population ageing, the reconciliation of employment and unpaid caring is becoming an important social issue. The estimation of the public expenditure costs of carers leaving employment is a valuable measure that is of considerable interest to policy makers. In 2012, the Personal Social Services Research Unit estimated that the public expenditure costs of unpaid carers leaving employment in England were approximately £1.3 billion a year, based on the costs of Carer's Allowance and lost tax revenues on forgone incomes. However, this figure was known to be an underestimate partly because it did not include other key benefits that carers who have given up work to care may receive. This paper presents a new estimate of the public expenditure costs of carers leaving employment. Key sources of information are the 2009/2010 Survey of Carers in Households, 2011 Census and 2015/2016 costs data. As well as Carer's Allowance, the estimate also now includes the costs of other benefits that carers leaving work may receive, namely, Income Support and Housing Benefit. The results show that the estimated numbers of carers who have left employment because of caring have increased from approximately 315,000 to 345,000. Due mainly to the inclusion of a wider range of benefits, the public expenditure costs of carers leaving employment in England are now estimated at £2.9 billion a year. The new estimate comprises £1.7 billion in social security benefits paid to people who have left their jobs because of unpaid caring, plus another £1.2 billion in taxes forgone on this group's lost earnings. The paper concludes that, if there was greater public investment in social care, such as 'replacement care' to support carers in employment, and fewer carers then left employment, public spending on benefits would be lower and revenues from taxation would be higher. [ABSTRACT FROM AUTHOR]

Background The evidence on public health interventions has traditionally focussed on a limited number of costs and benefits, adopted inconsistent methods and is not always relevant to the UK context. This paper develops a multi-criteria decision analysis (MCDA) approach to overcome these challenges. Methods A document review and stakeholder consultation was used to identify interventions and the criteria against which they should be assessed. The interventions were measured against these criteria using literature reviews and decision models. Criteria weights were generated using a discrete choice experiment. Results Fourteen interventions were included in the final ranking. Taxation was ranked as the highest priority. Mass-media campaigns and brief interventions ranked in the top half of interventions. School-based educational interventions, statins and interventions to address mental health problems ranked in the bottom half of interventions. Conclusions This paper demonstrates that it is possible to incorporate criteria other than cost-effectiveness in the prioritization of public health investment using an MCDA approach. There are numerous approaches available that adopt the MCDA framework. Further research is required to determine the most appropriate approach in different settings. [ABSTRACT FROM AUTHOR]

This TACTYC funded research highlights the role that Maintained Nursery Schools (MNS) play in supporting families within areas of extreme social deprivation in the UK. Data collected through survey and interview demonstrated the positive impact that these schools have upon disadvantaged children and their families, providing a breadth and depth of ongoing care, against a backdrop of ongoing fiscal cuts and uncertainty. Often this provision was in lieu of the reported minimisation of other social services support for struggling families. We argue in this paper that the loss of these state institutions could be highly detrimental to the families that they currently support. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

This paper investigates whether leaving school in a bad economy deteriorates health in the long run. It focuses on low-educated individuals in England and Wales who entered the labour market immediately after the 1973 oil crisis. Our identification strategy relies on the comparison of individuals who left school at the compulsory age, were born in the same year and had a similar quantity of education - but whose school-leaving behaviour in different years (hence, different economic conditions) was exogenously implied by compulsory schooling laws. We provide evidence that, unlike school-leavers who did postpone their entry into the labour market during the recessions of the 1980s and 1990s, pupils' decisions to leave school at the compulsory age immediately after the 1973 oil crisis were not endogenous to the contemporaneous economic conditions at labour-market entry. We use a repeated cross section of individuals over the period 1983-2001 from the General Household Survey and adopt a lifecourse perspective, from 7 to 26 years after school-leaving. Our results show that poor economic conditions at labour-market entry are particularly damaging to women's health. For men, the health impact of poor economic conditions at labour-market entry is less obvious and not robust to all specifications. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper explores the economic thinking behind the UK Coalition government’s new framework for achieving local growth and the creation of Local Enterprise Partnerships in England. It does so in the light of recent debates about ‘space-neutral’ and ‘place-based’ policymaking. While the British government states its ambition to achieve greater spatial and industrial balance across England (and by implication the UK), we argue that so far at least there is a mismatch between the ‘rhetoric’ and ‘policies’ of local growth and its limitations. These relate to inconsistencies in the way that the different competing economic ideas in circulation within government have been adopted in practice. As a result, the paper highlights six key disconnects and limitations of the economics behind the move in England to local growth. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper draws on a small-scale study examining the experiences of highly vulnerable families with complex and enduring needs. The previous UK government and the current government have sought to develop policy and service initiatives that target families who present high levels of need and require high cost services. However, to date remarkably little is known about family perspectives and experiences. In this paper, family accounts of their experiences are presented and it is suggested that from these come some difficult practice questions. The family data reveal evident gaps in existing practice and challenges social work to 'think family' in new ways. The paper explores how families understand they are understood at the point of engagement, the assumptions that are made about family knowledge, and how families share and withhold information about their needs and experiences. In the discussion, the argument is made for the development of nuanced practice capable of recognizing and working with the ways highly vulnerable families 'do family', and the processes that support and inhibit professional interventions. [ABSTRACT FROM AUTHOR]

A central element in the privatization of council housing has been the development of stock transfer policy. A variety of perspectives on this process have been explored including the impact on accountability relations; however, the tenants’ experience is almost completely absent from this literature. The paper develops a case study that draws on the experience of the tenants involved in a stock transfer. In the process stock transfers, and related accountability relations, are shown to be contested with tenant-led campaigns challenging this neoliberal inspired policy. The case study illustrates the power and financial resource asymmetries in transfer campaigns with a range of anti-democratic tactics employed by those pursuing the transfer. On the basis of a critique of neoliberalism, the stock transfer process is seen as an attack on the previous democratic control of council housing, which is replaced with ‘governance by experts and elites’ and private sector inspired corporate governance forms of accountability. Thus the paper seeks to answer two questions; how democratic is the transfer process and what are the long-term implications for democratic accountability in the social housing sector. [ABSTRACT FROM PUBLISHER]

Objective: This study reviewed all rhinology clinical negligence claims in the National Health Service in England between 2013 and 2018. Method: All clinical negligence claims held by National Health Service Resolution relating to rhinology in England between 1 April 2013 and 1 April 2018 were reviewed. Results: There were 171 rhinology related claims with a total estimated potential cost of £13.6 million. There were 119 closed claims (70 per cent) with a total cost of £2.3 million, of which 55 claims resulted in payment of damages. Over three quarters of all rhinology claims were associated with surgery (n = 132). Claims associated with endoscopic sinus surgery had the highest mean cost per claim (£172 978). Unnecessary pain (33.9 per cent) and unnecessary operation (28.1 per cent) were the most commonly cited patient injuries. Conclusion: Patient education and consent have been highlighted as key areas for improvement from this review of rhinology related clinical negligence claims. A shift in clinical practice towards shared decision making could reduce litigation in rhinology. [ABSTRACT FROM AUTHOR]

This paper analyses the myth of the Blitz spirit in British newspaper discourses of the City and economy after the London bombings on 7 July 2005. The Blitz spirit is a popular story of Britain during the Second World War, uniting together with defiance and resilience to overcome the threat of invasion from Nazi Germany. Through Barthes’ model of myth, this paper discusses the myth of the Blitz spirit in memories of wartime London. A critical discourse analysis then explores the ideological impact of Blitz spirit discourses in hyperbolised coverage of City traders and the economy in 2005. I argue that the ideological complexities of Western economics and the free market were suppressed by a myth that sought to bind social classes together through evocations of British, wartime solidarity and defiance. But, this paper also argues that Blitz spirit evocations among City traders were contradicted by discourses that discussed British citizens as consumers through anxieties about the economy after the bombings. [ABSTRACT FROM PUBLISHER]

This paper offers a re-interpretation of the development of practical mathematics in Elizabethan England, placing artisanal know-how and the materials of the discipline at the heart of analysis, and bringing attention to Tudor economic policy by way of historical context. A major new source for the early instrument trade is presented: a manuscript volume of Chancery Court documents c.1565-c.1603, containing details of a patent granting a monopoly on making and selling mathematical instruments, circa 1575, to an unnamed individual, identified here as the instrument maker Humphrey Cole. Drawing on economic and legal history, the paper argues that practical mathematics needs to be understood as one 'project' among many, at a time when monopoly patents were used to advance industry, lower unemployment, secure the realm and reward invention. Drawing on the history and sociology of technology, it argues that the management and control of materials - mathematical instruments themselves, and the local socio-legal context within which they could be made - needs to be understood as prior to and separate from the rhetoric of mathematical authors, which is of interest in its own right but which may not have a direct relationship to mathematical practice.

This paper considers how local areas become stuck in poverty traps and develops models exhibiting thresholds, where deprivation has to fall to a certain level before taking off. Using aggregate data for local authorities, the paper models cross-section movements of house prices to identify the threshold level of poverty. The paper argues that the resource requirements for bringing the most deprived areas to the take-off point are likely to be high. But for areas that are already close to the threshold, regeneration can be successful. Therefore, identifying the thresholds is important. Testing for thresholds is not straightforward, but the paper provides empirical evidence. The implications for policies concerned with social mixing are not encouraging. However, mixing may be more successful in areas that lie close to the threshold. For example, few high-income households want to live in the most deprived areas if the expected capital gains are low. But capital gains are maximised close to the take-off points. [ABSTRACT FROM AUTHOR]

Drawing upon a unique large-scale data source (n=5,004) and motivated by the time allocation model of consumer demand in economics, this paper critically analyses the relationship between the expenditure from, and duration of, same-day visits that comprise a large component of the domestic tourism market in England. It focusses on the contribution of activity sports tourism as a component of same-day visits. Three-stage least squares (3SLS) instrumental variable estimation is employed to account for the simultaneous determination of duration and expenditure as implied by economic theory. Controlling for socio-economic characteristics and general trip behaviours, the research identifies that although total expenditures and trip durations are positively related, there are trade-offs between these when focussing on the direct effects of the activities undertaken. However, accounting for the interrelationship between the duration of visits and the expenditures on them, it is found that walking reduces the expenditures on trips and their duration. Field sports increase them both. No effects are identified for running and cycling, as land-based activity sports tourism, or swimming and water sports, as water-based activity sports tourism. The key drivers of expenditure, which also increase the duration of trips, are visiting attractions and hospitality. The research provides a theoretically informed and empirically robust foundation for a more nuanced and targeted activity sports tourism strategy, which might have implications for how activity sports tourism may contribute to health and well-being and local economic development to better inform tourism planning and policy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to analyse the current nature and content of biodiversity reporting practices adopted by English local councils. By adopting a multi-theoretical framework that relies on economic and social theories such as agency, stakeholder, legitimacy and institutional theories, this study also aims to investigate the factors that explain the extent of biodiversity disclosure provided by local councils. Design/methodology/approach: This study uses a self-constructed disclosure index to analyse the biodiversity-related information published in the official websites of 351 English local councils. A multivariate analysis was conducted to analyse the association between local councils' characteristics and biodiversity disclosure. Findings: This study shows that the information disclosed on local biodiversity is limited and does not allow the interested stakeholders to get a comprehensive picture of the current status of local biodiversity. It also provides evidence that the level of biodiversity disclosure is significantly associated with the level of local council's population, the presence of councillors from environmentally oriented parties and environmental non-governmental organisations operating in the local council area, poor biodiversity management practices and local councils' visibility. Originality/value: This study is one of the few accounting studies that provides a comprehensive analysis of biodiversity disclosure by analysing its nature and content and investigating the factors associated with such disclosure. It extends agency, stakeholder, institutional and legitimacy theories, by showing that local councils use voluntary disclosures to satisfy the informational needs of the main stakeholders and to assure that their strategies and practices conform to the values and expectations of the community they represent. [ABSTRACT FROM AUTHOR]

Much of the recent literature concerned with the impacts of factory closure refers to closures occurring in the 1980s and 1990s and affecting heavy industry - coal, steel and shipbuilding. It also tends to focus on employment and labour market impacts assessed through the subsequent experience of workers made redundant following closures. It also tends to assume that these impacts are localized. Because of this much of the discussion of policy implications relates to the workers made redundant and to a very local economy. This paper refers to the closure of the MG Rover factory in Longbridge, Birmingham, UK. This closure was regarded as presenting a crisis for government and the local community. The paper responds to arguments in the research literature and explores the spatial and economic impact of the MG Rover closure in more detail. It complements other research which has focused on the experience of those made redundant in 2005 by referring to the loss of employment over a longer time period and identifying a wider impact spatially and socially. The paper draws upon different sources of evidence and concludes with a discussion of implications for policy and research. [ABSTRACT FROM AUTHOR]

Efficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an 'age of austerity' purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare service. This paper draws from a qualitative study conducted in three A&E Departments in England to explore the effects of austerity policies on the everyday experiences of doctors and nurses working in Emergency Departments. It discusses the operationalisation of efficiency in A&E, in a climate of austerity, and its effects on the experiences and practices of healthcare professionals. It uses the empirical data as a springboard to highlight the role of structures and regulations, in this case targets and protocols, in how core healthcare ethical values, such as empathy, are exercised in practice. It provides an analysis of the normative role structures and regulations can play on the perception and practice of professional duties and obligations in healthcare. [ABSTRACT FROM AUTHOR]

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This paper explores notions of cosmopolitanism and the ‘cosmopolitan city’ to interrogate how difference is constructed and treated in the contemporary entrepreneurial city. This is achieved through a grounded case study of the operationalising of notions of cosmopolitanism in Manchester, UK. This is examined in two ways. First, the construction of notions of the cosmopolitan city in the private-sector place marketing of a new ‘cosmopolitan city-centre lifestyle’ are analysed to reveal how urban reimaging creates a geography of difference in which certain forms of difference are valued or pathologised and fixed in space. Secondly, the analysis explores the contested ways in which the new city-centre ‘cosmopolitan’ residents understand and reproduce notions of cosmopolitanism and how this links to the treatment of difference in the city. The paper concludes by evaluating how interrogating notions of cosmopolitanism through a grounded urban case study, linking the textual analysis of urban imagery produced by the private sector to the political economy of the city, and investigating what actually happens in these new cosmopolitan city spaces contribute to the understanding of difference in the contemporary city. [ABSTRACT FROM AUTHOR]

This paper examines the treatment of ontology offered by critical realism. It addresses much of the material elaborated upon in two editions of this journal. Three main groups of criticisms are made here of the critical realist treatment of open systems. It is argued that critical realism, particularly in the project in economics emanating from Cambridge, UK, tends to define systems in terms of events. This definition is shown to be problematic. The exemplar of a closed system provided by critical realism of the solar system is shown to be flawed in that it is not closed according to the closure conditions identified by critical realism. Second, the negativity of the definitions adopted is problematic for heterodox traditions attempting to build positive programmes. Furthermore, the dualism of the definitions is also inconsistent with Dow's approach, which has ramifications for the coherence of post Keynesianism. Third, the definitions tend to polarize open and closed systems and ignore the degrees of openness evident in reality. The polarization of systems leads to polarized methodology and unsustainable arguments to reject so-called “closed-systems methods.” [ABSTRACT FROM AUTHOR]

For pilot or experimental employment programme results to apply beyond their test bed, researchers must select ‘clusters’ (i.e. the job centres delivering the new intervention) that are reasonably representative of the whole territory. More specifically, this requirement must account for conditions that could artificially inflate the effect of a programme, such as the fluidity of the local labour market or the performance of the local job centre. Failure to achieve representativeness results in Cluster Sampling Bias (CSB). This paper makes three contributions to the literature. Theoretically, it approaches the notion of CSB as a human behaviour. It offers a comprehensive theory, whereby researchers with limited resources and conflicting priorities tend to oversample ‘effect-enhancing’ clusters when piloting a new intervention. Methodologically, it advocates for a ‘narrow and deep’ scope, as opposed to the ‘wide and shallow’ scope, which has prevailed so far. The PILOT-2 dataset was developed to test this idea. Empirically, it provides evidence on the prevalence of CSB. In conditions similar to the PILOT-2 case study, investigators (1) do not sample clusters with a view to maximise generalisability; (2) do not oversample ‘effect-enhancing’ clusters; (3) consistently oversample some clusters, including those with higher-than-average client caseloads; and (4) report their sampling decisions in an inconsistent and generally poor manner. In conclusion, although CSB is prevalent, it is still unclear whether it is intentional and meant to mislead stakeholders about the expected effect of the intervention or due to higher-level constraints or other considerations. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to build upon existing knowledge of personalisation through an improved understanding of how the use of personalised social care services can support older people’s sense of self. It contains perspectives that are helpful to the development of personalisation policy and practice and to the future commissioning of social care services. Design/methodology/approach – The research involved a qualitative study with eight participants in two local authority areas in England. A series of three in-depth interviews conducted with each participant over a four to six week period explored their experience of using (in one case refusing) a direct payment to meet their social care needs. Ethical approval was obtained prior to the start of fieldwork via the research ethics committee of the author’s home university. Findings – Two inter-related themes emerge as findings of the research. First, that the locus of personalisation resides within the interpersonal dynamics of helping relationships; participants experienced personalisation when carers helped to meet needs in ways that validated their narrative of self. Second, whilst the experience of personalisation is not strongly related to consumer choice, it is important that older people are able to exercise control over and within helping relationships. Research limitations/implications – This is a small scale qualitative study conducted with only eight participants. Whilst it offers valid insights into what constitutes personalisation and the processes by which it was achieved for the participants, caution is required in applying the findings more generally. With the exception of one case, the study is focused exclusively on first person accounts of older people. Future studies might usefully be designed to incorporate the accounts of other involved parties such as family members and paid carers. Originality/value – The paper provides an alternative way of approaching personalisation of social care services for older people by exploring it in terms of its impact on self. It identifies the development of accommodations of “special requirements of Self” in helping relationships as a key mechanism of personalisation. This offers a balance to the current focus on consumer choice and control through the development of market like mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore government efforts to enhance the autonomy of community health services (CHS) in England through the creation of Foundation Trusts status. It considers why some CHS elected to become nascent Community Foundation Trusts (CFTs) while others had not and what advantages they thought increased levels of autonomy offered.Design/methodology/approach: Data are drawn from the evaluation of the Department of Health's CFT pilot programme. Participants were purposively selected from pilot sites, as well as from comparator non-pilot organisations. A total of 44 staff from 14 organisations were interviewed.Findings: The data reveals that regardless of the different pathways that organisations were on, they all shared the same goal, a desire for greater autonomy, but specifically within the NHS. Additionally, irrespective of their organisational form most organisations were considering an almost identical set of initiatives as a means to improve service delivery and productivity.Research Limitations/implications: Despite the expectations of policy makers no CFTs were established during the course of the study, so it is not possible to find out what the effect of such changes were. Nevertheless, the authors were able to investigate the attitudes of all the providers of CHS to the plans to increase their managerial autonomy, whether simply by separating from PCTs or by becoming CFTs.Originality/value: As no CFTs have yet been formed, this study provides the only evidence to date about increasing autonomy for CHS in England. [ABSTRACT FROM AUTHOR]

By embedding a spatially explicit ecosystem services modelling tool within a policy simulator we examine the insights that natural capital analysis can bring to the design of policies for nature recovery. Our study is illustrated through a case example of policies incentivising the establishment of new natural habitat in England. We find that a policy mirroring the current practice of offering payments per hectare of habitat creation fails to break even, delivering less value in improved flows of ecosystem services than public money spent and only 26% of that which is theoretically achievable. Using optimization methods, we discover that progressively more efficient outcomes are delivered by policies that optimally price activities (34%), quantities of environmental change (55%) and ecosystem service value flows (81%). Further, we show that additionally attaining targets for unmonetized ecosystem services (in our case, biodiversity) demands trade-offs in delivery of monetized services. For some policy instruments it is not even possible to achieve the targets. Finally, we establish that extending policy instruments to offer payments for unmonetized services delivers target-achieving and value-maximizing policy designs. Our findings reveal that policy design is of first-order importance in determining the efficiency and efficacy of programmes pursuing nature recovery. This article is part of the theme issue 'Bringing nature into decision-making'. [ABSTRACT FROM AUTHOR]

Variations in the character, performance and impact of policies and practices to capture land value for the community are usually examined by analysing experience in different countries. Such international comparative research is cross-sectional and does not cover the evolving relations between systems of land value capture and the economies, polities and societies within which they are set. This paper examines the relations in England between the extant political economy and supporting ideologies, and the distinctive forms of land value capture that they produced. It traces the shift from a top-down, strategic approach in an era of corporatist government before 1979 to the subsequent extension and consolidation of bottom-up practice set within the context of neo-liberalism. The analysis highlights the evolution of the idea of land value capture and the policies and practices associated with it, especially the contestation that informed such changes. [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]

This paper considers implications for the English voluntary sector of recent shifts in the terms of engagement with the state following rapid political and policy changes under the UK Coalition government. It explores how ideas of what constitutes the voluntary sector are being reconstructed in policy and practical settings, examining processes contributing to re-shaping the voluntary sector's conception of itself and beliefs about legitimate activities and aspirations. It draws on theories of institutional isomorphism and governmentality to explore these changes which appear to be modifying and restricting the voluntary sector's role in social welfare, limiting its influence and its ability to act simultaneously within and against the state. The paper argues the integral role of the state in recasting the roles of different sectors but also discusses the extent to which voluntary sector compliance is necessary to ensure organisational survival, asking what spaces exist for independent activity and resistance. [ABSTRACT FROM PUBLISHER]

Whilst an earlier paper (Part 1) in this journal describes the historical, political and economic drivers behind the creation of the City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS), this paper (Part 2) focuses on exploring the context within which the service functions. The paper provides an overview of its operational model and is organised into 10 sections. The first section outlines the service's clinical practice, whilst the second addresses the value of GP consultations as a core part of the PCPCS's provision. The third section addresses how the service, as departure from a more ‘pure’ psychoanalytic tradition of providing longer-term therapy, has managed its provision of brief treatments. There is a description of how the service manages its team of multi-disciplinary clinicians and their work in a variety of micro-cultures, conveying some of the challenges faced by the service and the team since its inception. Thereafter, the quantitative and qualitative evidence for the service's clinical and cost effectiveness is assessed, including outcome results and findings from a health economic evaluation. To illustrate some of the service's work in practice, some disguised clinical vignettes are presented. The paper also summarises the service's recent clinical innovations, as well as its contribution to the field of research, audit and training. Finally, the way forward for the service is considered in the context of current and emerging trends in psychological provision in primary care. [ABSTRACT FROM PUBLISHER]

Background Previous research suggests that the health effects of recessions are mixed and vary spatially between countries. Using the North-South English health divide as an example, this paper examines whether there are also spatial variations within countries. Methods Cross-sectional data on self-reported ‘not good health’ was obtained from the British Household Panel Survey and the Health Survey for England from 1991 to 2010. Age-adjusted generalized linear models were used to examine the effects of recessions (1990/91 and 2008/09) on self-reported health in the four English NHS Commissioning Regions (North, South, Midlands and London) with stratification by gender. Results Over the 20-year study period, the North had consistently higher rates of ‘not good health’ than the South [OR 1.50 (1.46–1.55) outside recessions and OR 1.29 (1.19–1.39) during recessions]. However, during periods of recession, this health divide narrowed slightly with a 2% decrease in the prevalence of ‘not good health’ in the North [OR 0.91 (0.86, 0.96)]. Conclusion This study is evidence of spatial variations in the health effects of recessions within England and the North-South divide appears to slightly reduce during recessions. Health in the North remains worse than the South. [ABSTRACT FROM PUBLISHER]