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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]

The aim of this paper is to evaluate the impact of differing decentralisation strategies - political, administrative and horizontal - on administrative performance subsequent to reform. In this respect, the paper presents core results from a comprehensive research project that has been carried out between 2006 and 2009 on the impact of decentralisation in three European countries. The aim of the project has been to develop and apply an analytical framework for the measurement of the effects of national decentralisation policies on local government performance. A total of six reform ventures were scrutinised in French, German and English local communities applying a multidimensional set of performance measures. Surprisingly, many of the theoretical assumptions about the effects of decentralisation strategies could not be confirmed. Moreover, straightforward relations were not discovered between decentralisation strategies and performance effects but between policy fields, political interests and the time elapsed since the reform and performance. [ABSTRACT FROM AUTHOR]

This paper considers contradictions between two concurrent and tacit conceptions of the Olympic 'legacy', setting out one conception that understands the games and their legacies as gifts alongside and as counterpoint to the prevailing discourse, which conceives Olympic assets as commodities. The paper critically examines press and governmental discussion of legacy, in order to locate these in the context of a wider perspective contrasting 'gift' and 'commodity' Olympics - setting anthropological conceptions of gift-based sociality as a necessary supplement to contractual and dis-embedded socio-economic organizational assumptions underpinning the commodity Olympics. Cost-benefit planning is central to modern city building and mega-event delivery. The paper considers the insufficiency of this approach as the exclusive paradigm within which to frame and manage a dynamic socio-economic and cultural legacy arising from the 2012 games. [ABSTRACT FROM AUTHOR]

The paper considers the proposal in England that a continuing requirement for residential developers to contribute directly to the supply of affordable housing in return for planning permission should operate alongside a new tax on land value increases due to planning permission. The paper asks whether it is right in principle for affordable housing to be supported by the implicit taxation of development. It is argued that in terms of transparency, clarity, and certainty explicit taxation is to be preferred to implicit taxation. It is thus suggested that once the new explicit tax is in place developers should no longer be routinely required to pay an additional implicit affordable housing tax. Affordable housing should, it is argued, be supported on the basis of need, not the resources available from the development process. The link between the provision of affordable housing and planning obligations should be broken. [ABSTRACT FROM AUTHOR]

New medicines represent exciting possibilities to individual patients for improved futures through reduced morbidity, as well as the potential for disappointment where promised outcomes are not forthcoming. For healthcare systems these technologies can enable enhanced effectiveness as well as spiralling costs, depending on value-for-money offered. Amidst uncertainty over efficacy and pricing, institutions such as the National Institute for Health and Clinical Excellence have been set up to regulate the cost-effectiveness of new products. The increased transparency of this new regulation, combined with inescapable uncertainties, leads to the heightened politicisation of decision-making and an insidious subjectivity beneath a veneer of rational-bureaucracy. This paper develops a theoretical framework for understanding the influence of hope within such contexts. Conceptualised here as ideological, affective and prone to lapsing into trust, hope is considered to shape the lifeworld-background of regulatory decisions and mask uncertainty around effectiveness. These processes challenge regulator legitimacy and effectiveness within polycentric regimes, through the distortion of communication and the manipulation of blame. [ABSTRACT FROM AUTHOR]

This article investigates the usefulness of cost-benefit analysis for the assessment of food safety policies, drawing on the experience of professional economists at the UK Food Standards Agency (FSA). After reviewing the history of Impact Assessment at the FSA, the example of the review of the over-thirty-months (OTM) rule is used to illustrate the advantages of the approach. We also highlight issues of uncertainty and intangibility, which create particular difficulties in applying cost-benefit analysis in the area of food safety. The paper concludes, however, that given the limited number of practical alternatives, cost-benefit analysis currently represents the best available approach to the assessment of food safety policies. [ABSTRACT FROM AUTHOR]

The article presents authors' comments on the paper "Some Problems in the Evaluation of Urban Road Investments," by M.E. Beesley and A.A. Walters. In the paper Beesley and Walters suggest a procedure for evaluation of urban road projects that differs in some important matters of principle from that developed in connection with the London Transportation Study (LTS), which is widely favored as the appropriate basis for economic evaluation. In considering taxation gain, Beesley and Walters say the argument for including this item as a benefit or cost must be, as is usual in cost benefit analysis, that it reflects a real benefit or cost to society in some sense. They said that on the assumption that some other taxes are reduced to compensate them, one should enter a benefit if the reduction in the marginal misallocation of resources and costs of collection of the reduced taxes offsets the costs of collection and misallocation effects of the taxes on the new road. They said that tracing out the misallocation effects and collection costs would be immensely complicated and thus, from ignorance, one must remain neutral as to whether any benefit exists.

Single-sided deafness presents communication challenges for adults. There are a range of care options, including CROS hearing aids, available but little is known about patient preferences for these interventions. The objective of this study was to understand the viewpoints of patients making decisions about audiological interventions they use. A constructivist worldview using thematic analysis to undertake a constant comparative analysis of 8 semi-structured interviews. Participants were recruited from Portsmouth Hospitals University NHS Trust audiology service in England. The results of the study describe ongoing iterative judgements being made by participants, informed by their access to information, effectiveness of audiological interventions, stigma, barriers to accessing care, and constant cost-benefit analyses being made. The key factors involved in decision-making by individuals with Single-sided deafness (SSD) are discussed. This study represents the first in-depth exploration of the individual's lifeworld related to which factors influence use of different audiological interventions by individuals with SSD. It highlights the complex and ongoing nature of how decisions are made by these individuals and identifies the need for greater information provision by clinicians, such as through use of a decision aid tool. [ABSTRACT FROM AUTHOR]

Objective: To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective.Methods: Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted.Results: When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV. For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses. For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this.Conclusions: For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving. [ABSTRACT FROM AUTHOR]

Children are not mini-adults, and thus require studies to be conducted in the population of interest to inform decisions about their care. The paucity of such studies for clinical efficacy lead them to be termed ‘therapeutic orphans’. Following the introduction of the ‘fourth hurdle’ of reimbursement approval on the basis of cost-utility analysis, utility data is now a key requirement for patients to access treatments in England and many other countries. This special report considers whether a paucity of utility valuation studies in children may have made them ‘economic orphans’ as well and presents results of a review of NICE appraisals as a window on this problem over time. [ABSTRACT FROM PUBLISHER]

Background. Activity-based funding mechanisms are widely used in acute care. In England, payment by results is being extended to mental health care, but its financial viability is unclear. Aims. To identify international examples of activity-based funding systems for mental health care and to inform the development of a national tariff in England. Method. The international literature on payment systems for mental healthcare services was reviewed. Payment systems were appraised from an economic perspective. Variations in cost between English mental healthcare providers were explored using routine inpatient data on length of stay in 2007/8. Results. The review identified activity-based mental healthcare payment systems in five countries. International experience highlights the need for gradual and stepwise implementation; the use of budget neutrality adjustments; top-slicing of budgets to stabilise provider income; and use of the classification system to drive improvements in quality and cost-effectiveness. All systems adjusted for length of stay, but methods varied. Comparing English mental healthcare providers, median length of stay ranged from 2 to 42 days for emergency admissions and from 0 to 56 days for elective admissions. Conclusions. New payment systems must account for the economic incentives they embody, and appropriate adjustments for variations in length of stay are essential. [ABSTRACT FROM AUTHOR]

This article illustrates and evaluates the use of the cost-effectiveness concept in local housing policy. It addresses this task by examining its application to two contemporary housing policy innovations in England - choice-based lettings (CBL) and homelessness prevention. The research assesses the costs and benefits to local public agencies of these policies through the use of the case-study method. It demonstrates that increased public expenditure to prevent homelessness or introduce CBL can be cost-effective. This finding supports the 'Best Value' agenda but the article demonstrates that the simple principle can be difficult to apply. The article offers a major contribution to the application of cost-effectiveness analysis within this context in elucidating the research processes and data required. We illustrate how the assessment of cost-effectiveness poses challenges in terms of both data availability and theoretical issues. Whereas the balance of costs and benefits may be clear, conclusions are often conditional or dependent on local circumstances. Major analytical constraints include the paucity of activity-based costing for social landlords, combined with the lack of a national protocol on cost accounting. Additionally, given that the measurement of potential benefits can be dependent on assumptions about long-term (market) outcomes there is a case for post-evaluation as well as pre-evaluation. [ABSTRACT FROM AUTHOR]

This article discusses the legacy of the 2012 Olympic Games in London, England for Great Britain as a whole. The relationship between viewing the Olympic games as a commodity subject to cost-benefit analysis and treating them as a gift proffered to the British people is addressed. The economic and cultural contributions of the Olympic Games to Great Britain are considered.

Previous findings have indicated that a letter from a patient's General Practitioner (GP) and a short GP consultation leads to reduced intake among long-term benzodiazepine (BZD) users. To compare the cost-effectiveness and potential cost savings of these two brief interventions. Economic evaluation conducted alongside a prospective randomised controlled trial from the perspective of the NHS. A total of 273 long-term BZD users (=>6 mos) at seven general practices and regarded by their GPs as suitable to take part in the study within the Newcastle and North Tyneside District Health Authority were identified from repeat prescription computer records. Patients were randomised to usual GP care + assessment only or the offer of a short consultation (12 mins approx) with the patient's GP (or practice pharmacist/practice nurse) or a letter signed by the GP advising gradual reduction in BZD intake. Economic measures taken were: costs of intervention; savings (costs) of changes in health service use from before to after intervention; savings to the NHS from reductions in drug use and dispensing costs; total costs of brief intervention; simulations of savings (costs) extrapolated to the District Health Authority. The letter was the more cost-effective intervention when taking into account changes in health service use and savings to the drugs bill. If all GPs in Newcastle and North Tyneside screened long-term BZD users on their lists and sent the letter studied here to those considered suitable to receive it, it is estimated that savings to the District Health Authority would be a minimum of £4.9 million per annum. Routine implementation of the letter intervention in general practice throughout the UK would result in large financial gains to the NHS. These savings represent a conservative estimate of savings to the public sector, as wider savings to the social care system may also be expected as a result of the policy. [ABSTRACT FROM AUTHOR]