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Support for school-age children with speech, language and communication needs (SLCN) usually takes place within the school setting. Successful outcomes for children with SLCN rely on effective collaborative working between speech and language therapists (SLTs), school staff and families. We need to understand the current evidence regarding the joint working practices, relationships and collaboration experiences of SLT and teaching staff within mainstream primary schools, in order to identify whether sufficient research exists for a systematic review within this field, and to inform practice. The purpose of this scoping review was to identify what research currently exists regarding collaboration, roles and relationships of SLTs and teaching staff within mainstream UK primary schools, and clarify the nature, participants and concepts described within this literature. A scoping review framework was used, consisting of identification of the review objectives, identification of relevant studies, study selection and iterative searches, data charting and reporting of the results. Information regarding research question, participants, data collection and analysis and terms used for key concepts was extracted. This scoping review identified 14 papers, however, collaboration was the primary focus of only 5 of these. Clarity and perceptions of roles were key themes within six of the papers. Whilst facilitators and barriers to collaboration are discussed in all 14 papers, only 4 studies aimed to investigate barriers and facilitators. Teaching assistant (TA) views are underrepresented within the research. Drawing conclusions from the body of research is challenging due to the varied ways in which the key concept 'collaboration' is used. Currently, there is insufficient literature to carry out a systematic review. This scoping review highlights the need for research that considers collaboration within the complex social network of school staff (including TAs) and SLTs, in order to ensure that future guidance is rooted in research. [ABSTRACT FROM AUTHOR]

In the UK, individuals with limited English-language proficiency (LEP) self-report poorer health and face challenges accessing health and social care support. Health and social care policies in English speaking countries provide practitioners with guidance that ensures access to public service interpreters for individuals who require them. The guidance simultaneously discourages the use of informal language brokers, including family and friends, suggesting that they are not educated or objective enough to conduct this role, and that they present unmanageable risks. This poses a challenge, as research exploring patient and service user choices, finds that individuals consistently prefer an informal language broker. The paper explores the contradiction between a legislative shift towards empowerment and choice within social work and the policies that restrict these rights in relation to interpretation. Exploring these challenges with a focus on policy and practice, leads to the suggestion that individuals should be empowered to choose who provides their language support. In contrast, existing policies increase the power imbalance between professionals and users of services, significantly affecting the life chances of those with LEP. [ABSTRACT FROM AUTHOR]

Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems in these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated that participants (N = 97) had endured a range of pre- and postmigratory stressors and had high scores on measures of anxiety, depression, and PTSD. A postmigratory factor comprising items associated with isolation, restrictive policies, and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma-focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile. [ABSTRACT FROM AUTHOR]

This paper discusses the main ideas of the Diversity Based approach to culturally sensitive practices in health and social care services.This approach is important in emphasizing the fluid nature of culture, the diversity in cultural groups and the impact of inegalitarian and racist power relations on their life. Chinese people in the UK are used as an example to demonstrate how exploration of the diversity of ethnic minority groups could strengthen cultural sensitivity. Some methods for the realization of the Diversity Based approach, such as the culturagram and user involvement, have also been highlighted. [ABSTRACT FROM PUBLISHER]

The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. [ABSTRACT FROM PUBLISHER]

Objectives: While the presence of publication bias in clinical research is well documented, little is known about its role in the reporting of health services research. This paper explores stakeholder perceptions and experiences with regard to the role of publication and related biases in quantitative research relating to the quality, accessibility and organization of health services. Methods: We present findings from semi-structured interviews with those responsible for the funding, publishing and/or conduct of quantitative health services research, primarily in the UK. Additional data collection includes interviews with health care decision makers as 'end users' of health services research, and a focus group with patient and service user representatives. The final sample comprised 24 interviews and eight focus group participants. Results: Many study participants felt unable to say with any degree of certainty whether publication bias represents a significant problem in quantitative health services research. Participants drew broad contrasts between externally funded and peer reviewed research on the one hand, and end user funded quality improvement projects on the other, with the latter perceived as more vulnerable to selective publication and author over-claiming. Multiple study objectives, and a general acceptance of 'mess and noise' in the data and its interpretation was seen to reduce the importance attached to replicable estimates of effect sizes in health services research. The relative absence of external scrutiny, either from manufacturers of interventions or health system decision makers, added to this general sense of 'low stakes' of health services research. As a result, while many participants advocated study pre-registration and using protocols to pre-identify outcomes, others saw this as an unwarranted imposition. Conclusions: This study finds that incentives towards publication and related bias are likely to be present, but not to the same degree as in clinical research. In health services research, these were seen as being offset by other forms of 'novelty' bias in the reporting and publishing of research findings. [ABSTRACT FROM AUTHOR]

The forensic care pathway that is the focus of this UK regional review has itself seen a considerable amount of change over the last decade, focusing on implementing wide reaching reform within both prison and health care. Reforms have seen a reduction in the number of people in some parts of the care pathway and new interventions and growth in other areas. At the end of 2009, the region that was subject to this review there had seen over 450 people cared for in high, medium or low secure services in that year and had a prison population approaching 10,000. The aim of the review was to understand the impact of these changes with a view to sustaining effective pathways and systems, and to increase impact and ensure value for money in order to improve the efficiency and quality of services. A primary objective was to consider the influence of statutory mental health provision upon the use of high, medium and low secure psychiatric services. It was proposed that from a regional perspective more needed to be understood about the influence of wider services upon the care pathways for people using secure services. This paper considers what is available from primary care locality and its features, alongside the rates of secure service use. It also acknowledges the wider influences upon the use of those services. [ABSTRACT FROM AUTHOR]

Background: The study reviewed the disciplinary composition of community mental health teams (CMHTs) and conducted a national survey of mental health providers in England and Wales to explore the determinants of the social care component of CMHTs. Methods: A comprehensive literature review and a national survey of NHSmental health Trusts in England and Wales. Results: The literature review showed that team composition was rarely well justified with regard to effectiveness, despite some evidence that greater professional diversity (i.e. inclusion of social workers) was associated with higher effectiveness. Forty-two mental health Trusts responded (53.2%) to the survey. There were no staffing differences between responding and non-responding Trusts. Social workers accounted for 19.3% of the staffing total. Nurses formed a third of the workforce and social support workers made up a further 10%. We found that there continues to be a shortage (compared to policy targets and previous research) of psychiatrists, psychologists and occupational therapists, whereas the numbers of nurses employed far exceeds their target numbers. Total staffing numbers appeared to be slightly higher in Trusts citing 'financial resources' as a determining factor of team composition. Despite being statistically non-significant, the 'financial resource' effect was of medium magnitude. Similarly, there was a non-significant but approaching medium-sized effect of higher numbers of social care support staff when guidance was cited as a rationale for CMHT composition. There was a non-significant (P 5 0.076) medium magnitude (η2 p 5 0.067) trend towards higher staff numbers in more integrated trusts that did not cite financial resources as a driver of team composition. Conclusions: If service recipients are to gain equal access to appropriately staffed services, further attention needs to be paid to supporting an adequately skilled multidisciplinary workforce. The workforce needs to be organised in a way that best provides for local needs rather than a service based largely on the existing supply of different professionals and disjointed workforce planning. [ABSTRACT FROM AUTHOR]

This paper examines some of the misapprehensions that have often underpinned the planning of accident and emergency services in the UK. Accident and emergency (A&E) is not a homogenous group of activities and the different components that make up the service should be planned separately. This planning needs to be accompanied by some significant redesign to meet growing patient expectations. In particular, there is a major challenge for services to offer local access in an environment in which acute care is increasingly centralized. [ABSTRACT FROM AUTHOR]

This paper contrasts the views of two prominent politicians on the ways in which the distribution of hospital services should be organised, and relates them to the views of Hayek on the nature of planning. It is argued that, in relying on an independent regulator to supervise access to health care under the new 'foundation' hospitals regime in the English National Health Service (NHS), not only is the Labour government distancing itself clearly from old-style top-down planning, it also risks greater variability in the definition of fair access to health care. There are relevant historical parallels with the mixed economy of the pre-NHS era that policy-makers should make explicit. [ABSTRACT FROM AUTHOR]

An editorial is presented on the 75th anniversary of the National Health Service (NHS) and advocates for a reevaluation of the advantages and shortcomings. It mentions the issues such as worker shortages, burnout, and rising demands. It include merging healthcare services, decreasing bureaucracy, and employing technology such as digital health, artificial intelligence. It highlights the viewpoint and long-term plan with cross-party support is essential for the NHS's future success.

Objectives: Gender service utilisation according to ethnicity is largely under-researched. The present research looked at demographics and service user-engagement according to ethnicity of young people accessing a gender service for children. Method: A total of 2063 (M = 14.19 years, SD = 2.59, assigned male = 556, 1495 assigned female = 1495, no-specification =12) referrals were included in the analysis. Self-defined ethnicity in financial years (FY) 2016–2017, 2018–2019, and referrer-defined ethnicity in FY 2020–2021 were compared between years, to the national UK-population, and child and adolescent mental health service (CAMHS) averages. Numbers of offered, attended and non-attended appointments were compared across the White and the ethnic minority population (EMP). Results: Across years 93.35% young people identified as White (higher than the CAMHS and national population averages); 6.65% as EMP. Service utilisation was similar in FY 2016–2017. In FY 2018–2019, the EMP subgroup was offered and attended more appointments compared to the White subgroup, 'did not attended' average was similar. Conclusions: The majority of young people self-identified with a White ethnic-background. Service engagement was comparable between the EMP and White ethnicity subgroups in 2016–2017, while the EMP group was offered and attended more appointments in 2018–2019. Due to the low EMP group numbers, findings need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Social care provision across high-income countries has been transformed over the last ten years by personalisation – a policy agenda to give people with eligible support needs more choice and control over their support. Yet the ideological underpinnings of this transformation remain highly mutable, particularly in the context of reduced welfare provision that has unfolded in many nations advancing personalisation. How the policy has manifested itself has led to an expectation for people to self-build a life as individual consumers within a care market. This article draws on a study exploring how people with learning disabilities in England and Scotland are responding to the everyday realities of personalisation as it is enacted where they live and show the relationality inherent in their practices. We propose that the personalisation agenda as it currently stands (as an individualising movement involving an increasing responsibilisation of individuals and their families) ignores the inherently relational nature of care and support. We propose that social care policy needs to recognise the relational ways in which people build their lives and to advocate a redistribution of responsibility to reduce inequalities in the allocation of care. [ABSTRACT FROM AUTHOR]

COVID-19 has had a significant and measurable impact on individuals and families in economically deprived areas both in the United Kingdom and internationally. This article examines issues of community resilience and service adaptability and focuses on the period during the first lockdown in the United Kingdom (May to July 2020). Data were collected from members of the local community in Southend, with specific reference to the 'A Better Start Southend' programme of support. The evidence presented in this article uncovers the impact of the 'first lockdown' on families with young children, and local children's and community services. [ABSTRACT FROM AUTHOR]

Aims: Considerable progress in public health is expected to occur from the application of genomic knowledge and technologies. This is the subject of a newly emerging field of public health genomics. In this paper we analyze differences in how public health genomics is developing in the Netherlands, the UK and Germany through the definition and diagnosis of familial hypercholesterolaemia (FH), an inherited predisposition for coronary heart disease. Methods: We analyzed the emergence of public health genomics within the framework of a project on the incorporation of genetics in western European healthcare schemes. Our analysis is based on document analysis and in-depth interviews. Results: In the Netherlands, public health genomics takes shape through a genetic screening programme for FH, looking for mutations on two specific genes; in the UK it emerges through a strategy of ‘‘mainstreaming’’ genetics in health care that aims to identify hereditary predispositions by means of phenotypic diagnosis; and in Germany public health genomics is elaborated at a conceptual level, leaving a diagnosis of FH to individual physicians who occasionally prescribe genetic testing. Conclusions: Our analysis shows how public health genomics gets constituted differently in different countries and, moreover, produces particular patterns of inclusion and exclusion from care. These patterns indicate a paradox in public health genomics, which consists of an inverse relationship between the use of advanced molecular genetic testing technologies and the number and variety of individuals at risk included in the target population. This paradox presents a challenge for professionals and policy makers in public health genomics. [ABSTRACT FROM PUBLISHER]

This article aims to highlight the delivery of health care to people with learning disabilities (PWLD) in the context of new Department of Health guidance and implementation of the Mental Capacity Act (2005). We seek to identify a myriad of barriers to health care delivery in this population and look at strategies to tackle these barriers. We will also consider the issue of capacity, which is particularly important for PWLD. We will highlight the importance of recognizing this population's enhanced baseline medical morbidity and how a best interests team approach is optimal when targeting interventions. [ABSTRACT FROM PUBLISHER]

The LGBT Action Plan (2018) represents a significant UK government commitment towards LGBTQI+ equalities, operating in conjunction with cumulative legislative advances. Yet there is room for critique within this Plan, as proposed actions and as celebratory rhetoric of lives 'getting better'. Using empirical examples, this article examines how 'progress' for LGBTQI+ lives is discursively constructed and positioned in the LGBT Action Plan and accompanying politicians' speeches. We examine the key constructions of progress – across time, place, lifecourses, and normative thresholds – within which LGBTQI+ rights and realities are framed. We draw upon queer theory to illuminate discursive normativities and silences in representing 'policy problems' (Bacchi, 2009). While some policy areas are celebrated as signifiers of 'coming forward', others are relegated to the too tough in-tray, suspended in enduring stasis. Opposing 'political time' with 'queer time', this article concludes with the policy challenges posed by intersectional (in)equalities in these 'new times'. [ABSTRACT FROM AUTHOR]

Taking a social model of disability approach, this article explores how disabled people negotiate barriers in the large, modern hospital settings typically found in complex healthcare systems. While there is evidence of intractable barriers in the United Kingdom's National Health Service, little is known about the actions disabled people take in the face of barriers and the immediate effects of doing so. Analysis of data from a qualitative study of disabled people's healthcare encounters is presented. This draws on the concept of threats to embodied well-being to understand how disabled people perceive barriers and the influence this perception has on barrier negotiation. It demonstrates that some barriers are unique to healthcare and that these place disabled people in situations where their well-being is threatened. Despite these situations being inherently disempowering, disabled people are forced to take whatever action they can to protect the embodied self. We theorise that barriers are created inadvertently by the design, organisation and healthcare practices characteristics of modern hospital settings. Effective barrier removal requires understanding not only their impact on disabled people's embodied well-being, but also the political, policy and social relations implicated in their creation. [ABSTRACT FROM AUTHOR]

Depression in young people is common and impairing. There have been significant service changes in the United Kingdom in the last decade, aiming to improve access to evidence-based interventions for depression. However, it is unclear whether youth with depression, first, access services and, second, receive appropriate interventions. In the current study, anonymised data from child and adolescent mental health services were extracted from a 1-year period at two time points (time 1: n = 770; time 2: n = 733). First, these were compared with prevalence and population data. Second, a subsample (n = 45 at each time point) was evaluated against National Institute for Clinical Excellence (NICE) guidelines. Approximately, one-quarter of the expected number of cases (according to population and prevalence data) were seen in the 12 to 18-years age group, and only 2% of expected cases were seen in the 0 to 11-years age group. This was consistent across time points. Adherence to NICE guidance was mostly good at both time points, but there were concerns raised by this evaluation, in particular the use of medication in this population. From time 1 to 2, there was an increase in use of questionnaire measures, but a decrease in the correct completion of risk assessments. [ABSTRACT FROM AUTHOR]

This article analyses childcare services in six countries, assessing this policy instrument's potential to facilitate parents' capabilities for arranging childcare in a way they have reason to value. It draws on Sen's capability approach to conceptualize and assess childcare policy design across five key aspects of childcare provision (accessibility, availability, affordability, quality and flexibility) in a country-comparative perspective. The conceptualization of the multifaceted nature of childcare provides compelling insights into the complexity of comparing childcare services across countries. The ensuing analysis and comprehensive overview of national policies challenges the idea of a defamilialization policy cluster, which masks key distinctions between public and market service provision. The more nuanced conceptualization and operationalization of childcare policy design through the capability approach reveals parents' real opportunities for arranging childcare and the varying effects of policy design across gender and class. In addition, it goes beyond implicit commodification assumptions and opens up space for parents' potential desire for multiple care arrangement possibilities. [ABSTRACT FROM AUTHOR]

This article reports on a study of local implementation in the UK Troubled Families Programme (TFP). Exploring the experiences of 12 families, the policies of local bureaucrats, and a critical reading of the literature, we argue that the local case represented an attempt to partially renegotiate disciplinary elements of the national programme and to recognise that the families were affected by structural poverty and inequality. Locating the TFP in the literature on disciplinary social policy, multi-scale 'Fast Policy' and the potential for local subversion through the agency of frontline workers, we suggest that the local attempts to renegotiate programme priorities were partially successful. These attempts were characteristic of 'contingent coping' in terms of both institutional processes and outcomes for the families involved. The evidence reported is significant and timely in the context of the expanded and relaunched TFP and this shapes our commentary on the recently published Improving Lives strategy. [ABSTRACT FROM AUTHOR]

Background: Little is known about how social and cultural variants interact with gender identity development. This article aims to identify the ethnicities of children and young people referred to the United Kingdom's national Gender Identity Development Service (GIDS), and compare the ethnicity data with the UK child population and referrals to Child and Adolescent Mental Health Services (CAMHS). Methods: GIDS referrals made between April 2012 and April 2015 for children and young people were retrieved. Ethnicity data were obtained by the '16 + 1' ethnicity list. Chi-square and t -tests were performed on the demographics. Results: Less than 10% of the 995 referrals at GIDS were from Black and minority ethnic (BME) groups – an underrepresentation as compared with both the national population and CAMHS figures. No significant differences in ethnic representation were found between the demographic birth-assigned sexes, across age groups, or year of referral. Conclusions: Hypotheses proposed for this underrepresentation take into account both the potential barriers to accessing services and the possibility of cross-cultural variations in the conceptualisations of gender, gender roles and gender diversity. Ethnicity, culture and religion, and their overlapping relationship with gender need further exploration. [ABSTRACT FROM AUTHOR]

Objective: Qualitative research has identified personal costs and benefits for peer supporters associated with their role; however, quantitative evidence is sparse. This study used quantitative methods to explore relationships in experiences of providing peer support with constructs of empowerment, hope, recovery, quality of life and internalised stigma. Differences were examined for those in statutory versus non-statutory services; who had themselves received peer support versus those who had not and who identified having had negative experiences in clinical teams versus those without such experiences. Methods: A cross-sectional online and postal survey was undertaken in tandem with a linked consensus study. In all, 147 peer supporters were recruited from a variety of organisations across the United Kingdom. Validated questionnaires were used to examine constructs. Instruments created for the study measured peer support experiences, and personal costs and benefits involved. Correlations were calculated and results informed further regression analysis. Chi-square tests and independent samples t-tests tested group differences. Results: Peer supporters indicated they experienced almost twice as many role-related personal benefits than personal costs. Benefits included improvements to mental health and well-being, reduced use of services, increased social functioning and development of skills. Total number of personal costs experienced was significantly negatively related to peer supporters' empowerment and quality of life. There were no significant differences between the groups examined. Conclusions and Implications for Practice: An accumulation of personal costs may result in reduced quality of life; however, costs can be minimised by organisations. Limitations of the research are discussed and recommendations for future research are made including the need for longitudinal research. [ABSTRACT FROM AUTHOR]

Background: While formalised mental health peer support is on the increase, there continues to be a lack of consensus regarding the peer supporter role. Aim: The aim was to develop consensus on the essential components, personal costs, personal benefits, barriers and facilitators involved in providing mental health peer support. Methods: The Delphi method was used. In the first round, an exhaustive list of statements pertaining to peer support was generated from literature review and consultation with experienced peer supporters. In the second round, 147 UK peer supporters rated statements online or via post, and completed a questionnaire about experiences of providing peer support. Criteria for consensus were applied. Where there was uncertainty, statements were re-rated. Descriptive statistics and group comparisons were calculated. The final statements were grouped thematically. Results: Consensus was reached on statements pertaining to essential components (n = 67), personal benefits (n = 21), barriers (n = 1) and facilitators (n = 35). Formal peer support involves many skills and competencies. Most participants agreed that a wide range of personal benefits come with the role. Organisations may facilitate peer support through their values, actions and oversight. Approximately half of the sample worked in public services and were more likely to have concerns regarding pay and career progression. Conclusion and Implications for Practice: Results define the peer supporter role and add to the knowledge base about optimal conditions for it to thrive. Recommendations are made regarding role development and career progression, and future research to better understand personal costs and benefits. [ABSTRACT FROM AUTHOR]

Background: Social inclusion of people with mental health issues is an aim of the World Health Organisation. Many countries have adopted that objective, including Brazil and the United Kingdom and both have focused treatment in the community. The aim of this article is to compare international results using the same inclusion instrument. Methods: The samples in this study were 225 people with mental health issues in community services in São Paulo, Brazil. Their results are compared to findings from 168 people with similar mental health issues in Hong Kong, China, and from the United Kingdom – a nationally representative sample of 212 people without mental health issues. The instrument used to measure a social inclusion called Social and Communities Opportunities Profile (SCOPE) has been validated for use in the United Kingdom, China and Brazil. Results: The results are that people with mental health issues have worse social inclusion when compared to general population. Between the people with mental health issues, the sample of São Paulo has the lowest social inclusion index but, in relation to access to the Brazilian revised mental health services, that sample has a similarly high inclusion rating to the general population of the United Kingdom. Conclusion: Findings are important to understand mental health in the community context, as well as their adversities and potentialities. [ABSTRACT FROM AUTHOR]

Copyright of International Social Work is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Breastmilk is widely considered as the optimum nutrition source for babies and an important factor in both improving public health and reducing health inequalities. Current international/national policy supports long-term breastfeeding. UK breastfeeding initiation rates are high but rapidly decline, and the numbers breastfeeding in the second year and beyond are unknown. This study used the concept of liminality to explore the experiences of a group of women breastfeeding long-term in the United Kingdom, building on Mahon-Daly and Andrews. Over 80 breastfeeding women were included within the study, which used micro-ethnographic methods (participant observation in breastfeeding support groups, face-to-face interviews and online asynchronous interviews via email). Findings about women's experiences are congruent with the existing literature, although it is mostly dated and from outside the United Kingdom. Liminality was found to be useful in providing insight into women's experiences of long-term breastfeeding in relation to both time and place. Understanding women's experience of breastfeeding beyond current usual norms can be used to inform work with breastfeeding mothers and to encourage more women to breastfeed for longer. [ABSTRACT FROM AUTHOR]

While poor communication between service users and front-line staff causes many service user complaints in the British National Health Service, staff rarely reflect on the causes of these complaints. We discuss findings from an action research project with midwives which suggest that the midwives struggled to fully understand complaints from women, their partners and families particularly about restricted visiting and the locked door to the midwifery unit. They responded to individual requests to visit out of hours while maintaining the general policy of restricted visiting. In this way, the door was a gatekeeping device which allowed access to the unit within certain rules. The locked door remained a barrier to women and their families and as a result was a common source of informal complaints. We argue that the locked door and restricted visiting to the midwifery unit were forms of gatekeeping and boundary making by midwives which reveals a tension between their espoused woman-centred care and contemporary midwifery practice which is increasingly constrained by institutional values. [ABSTRACT FROM AUTHOR]

In 2011, Hounslow public health opened a dialogue with probation, asking what the obstacles were, in terms of access to healthcare. The first issue raised was a difficulty in clients registering with a GP practice. This formed the start of a robust partnership between probation, public health, the forensic mental health practitioner, GPs and community health services. The health and well-being initiatives have included GP registration, with 10 dedicated practices for probation and Drug Intervention Programme clients, in-house stop smoking support, and the start of a health trainer scheme. This work will help to reduce health inequalities in a marginalized and underserved group and also meet the goals for both public health and criminal justice agencies [ABSTRACT FROM PUBLISHER]

The article discusses a study undertaken as part of the Evaluation of Care Across Borders (ECAB) project on cross-border care collaborations with the aim of describing pediatric cross-border care pathways and identifying factors that support or hinder its operation. Topics discussed include the Malta-Great Britain agreement that provides for free treatment of up to 180 Maltese patients in Great Britain every year where patients referred above this quota incur a charge to the Maltese government.

The article presents a cohort study on deprivation's impact on the health outcomes, occurrence and medical care cost of multiple morbidity patients in England. It mentions the application of deprivation quintile (IMD2010) at the level of individual postcode as well as the incidence and mortality of diabetes mellitus, stroke and depression for defining multidisease conditions. An overview of data analysis based on disease incidence, deaths and events is also provided.

The Health and Social Care Bill proposes clinically led commissioning. The new Clinical Commissioning Groups will become statutory bodies and replace the old primary care trusts. This primary legislation will transfer accountability for health care spending to clinicians who will have a duty to meet the health needs of a population as well as balance a budget. This change gives rise to a number of ethical issues which are explored in this article. [ABSTRACT FROM AUTHOR]

Copyright of International Social Work is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Calls for the treatment of chronic fatigue syndrome (CFS) in primary care have been based largely on considerations of the availability and accessibility of resources rather than with reference to a firm evidence base. Treatments such as cognitive–behavioural therapy and graded exercise therapy, which have proven effective for CFS in secondary and specialist care settings, have not been adequately tested in primary care. There are several factors that may affect the generalizability of such treatments. Patients seen in primary care may differ from those seen in secondary care, in terms of both illness beliefs and social characteristics, and these factors need to be taken into account when developing and adapting treatments for primary care. While some primary care physicians experience difficulties in the diagnosis of CFS, we argue that early and authoritative diagnosis and the provision of a tangible explanation for patients' symptoms are likely to be beneficial. Because of the scarcity of qualified specialist therapists, we need to train primary care practitioners to deliver treatments, and we need more research into the feasibility and effectiveness of doing this. Finally, the primary care setting offers opportunities for the guided development of patient self-help approaches. [ABSTRACT FROM AUTHOR]

The author reflects on the significance of the use of clinically integrated health care delivery systems in the National Health Service in Great Britain. Due to multiple complaints and symptoms being presented by patients, the author suggests the necessity of having the essential knowledge and perspectives of various specialties to bear the problems of patients in a seamless and economical way. He notes that clinical integration is a significant advancement in medical care.

The article reviews several web sites including www.controlled-trials.com from the Medical Research Council in Great Britain, http://wwwcf.nlm.nih.gov, and http://public.ukcrn.org.uk from UK Clinical Research Network Study Portfolio.