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This paper explores the effectiveness of paid services in supporting unpaid carers’ employment in England. There is currently a new emphasis in England on ‘replacement care’, or paid services for the cared-for person, as a means of supporting working carers. The international evidence on the effectiveness of paid services as a means of supporting carers’ employment is inconclusive and does not relate specifically to England. The study reported here explores this issue using the 2009/10 Personal Social Services Survey of Adult Carers in England. The study finds a positive association between carers’ employment and receipt of paid services by the cared-for person, controlling for covariates. It therefore gives support to the hypothesis that services for the cared-for person are effective in supporting carers’ employment. Use of home care and a personal assistant are associated on their own with the employment of both men and women carers, while use of day care and meals-on-wheels are associated specifically with women's employment. Use of short-term breaks are associated with carers’ employment when combined with other services. The paper supports the emphasis in English social policy on paid services as a means of supporting working carers, but questions the use of the term ‘replacement care’ and the emphasis on ‘the market’. [ABSTRACT FROM PUBLISHER]

In mental health, communication is thesine qua non, not only for considering a diagnosis, but also for developing a treatment plan. Words, on the one hand, and the relationship between the clinician and the service user, on the other, are two of the main components of mental health and therapeutic treatment. The presence of an interpreter has the potential to have an effect on the dynamics of the mental health or therapeutic encounter. This may pose a series of challenges and opportunities for all three members of the triad. This paper reports on a study conducted with interpreters working with recent migrants, mainly refugees and asylum seekers at two organisations based in the South of England. Two focus-groups with interpreters were conducted. Several differences between interpreting in mental health and interpreting in other settings were noted by the interpreters. Five overarching themes were identified in this study. These were: the role of the interpreter in the mental health encounter, the dynamics within the therapeutic triad, the interpreter-clinician relationship, power and alliances within the room and the personhood of the interpreter. The first two themes are presented within this paper, although the themes are not entirely discrete categorisations. [ABSTRACT FROM PUBLISHER]

Background: The level of frailty in the older population across age cohorts and how this changes is a factor in determining future care costs and may also influence the extent of socioeconomic and gender inequalities in frailty. Methods: We model cohort-specific trajectories in frailty among the community dwelling population older than 50 years, using five waves (2002–2010) of the English Longitudinal Study of Ageing. We stratify our analysis by wealth and gender and use a frailty index, based on accumulation of ‘deficits’. Results: For males and females between the ages of 50 and 70 in 2002, frailty trajectories for adjacent age cohorts converge. However, levels of frailty are higher in recent compared with earlier cohorts at the older ages (for cohorts aged over 70 in 2002). These cohort differences are largest in the poorest wealth group, while for the most affluent, frailty trajectories overlap across all adjacent cohorts suggesting no change across cohorts. Conclusions: A key driver of the cohort differences in frailty that we observe is likely to be increased survival of frail individuals. Importantly, this paper illustrates that the social conditions experienced across the wealth distribution impacts on the rate of deficit accumulation in older populations. Our results on trajectories of frailty between 2002 and 2010 are pessimistic and, in the context of rising life expectancies, suggest that poorer older people in particular spend additional years of life in a frail state. [ABSTRACT FROM AUTHOR]

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]

Purpose -- The purpose of this paper is to explore physical and mental health patients' experience of multidisciplinary team (MDT) care and decision making in order to highlight factors underlying effective care and to identify areas in which patient experience could be improved. Design/methodology/approach -- Totally, 12MDTs within the North Thames area participated; the authors recruited 13 patients from physical health MDTs and seven patients from mental health MDTs. The authors conducted semi-structured interviews with each participant and thematically analysed the transcripts. Findings -- The study found a marked contrast in patient experience: physical health patients emphasised their faith in the judgement of MDT clinicians, described experiencing high quality care and expressed a strong preference not to attend MDT meetings; mental health patients highlighted a range of negative experiences, were frequently sceptical about their diagnosis, and expressed a desire to have greater involvement in the decisions directing their care. Research limitations/implications -- It was necessary to revise the initial target of interviewing six patients per MDT due to recruitment difficulties. Practical implications -- In order to improve care, mental health MDTs should focus on promoting a shared understanding of illness by increasing the transparency of the diagnostic process. Key factors underlying effective MDTcare in physical health services include enabling patients to determine their level of involvement in decision making and ensuring patients have a clear understanding of their care plan. Originality/value -- The paper highlights the importance of mental health MDTs focusing on developing a shared understanding of illness with their patients. [ABSTRACT FROM AUTHOR]

Multi-touch surfaces have the potential to change the nature of computer-supported collaborative learning, allowing more equitable access to shared digital content. In this paper, we explore how large multi-touch tables can be used by groups of students as an external representation of their group interaction processes. Video data from 24 groups of students working on a logic reasoning problem was examined to identify their levels of reasoning about the task, and how they used the table to support their reasoning. Results indicate that of the 13 groups who solved or nearly solved the problem, 12 used the table to represent their reasoning process, while only four groups who used the table to support their reasoning process did not solve the problem. Examples from three groups are used to explore the different ways the table was used as an external representation of the groups' processes. The findings indicate that the group problem-solving process can be enhanced with the use of multi-touch tables, although students may need support in using the technology effectively to support their collaborative reasoning. [ABSTRACT FROM AUTHOR]

Accessible summary This paper reports on the issue of resuscitation in mental health inpatient environments. It reviews the literature on national standards and best practice when emergency situations arise in mental health settings. The discussion on the best practice literature takes place alongside the reporting of a national evaluation of how National Patient Safety Agency improvement guidelines for the provision for life support, and resuscitation for mental health service users was effectively implemented across health-care providers in England., Methods used to establish the effective use of the guidelines include feedback from clinical staff and staff responsible for the implementation of the new national standards for resuscitation. Serious incident data were also compared prior to the release of the national guidelines and after the guideline release dates. This included looking at events around choking and cardiac/respiratory arrest in inpatient areas., There were five deaths post-implementation of the guidelines that were considered to have serious enough error associated with the resuscitation process. This was down from 18 prior to the release of the guidelines. However, our survey showed that despite organisations reporting 100% compliance with the implementation of the guidelines, around half of frontline clinical staff were not aware of them., Although our survey responses show a contradiction between organisational and clinical staff awareness, our analysis suggests a reduction in moderate and severe harm cases and of deaths. There is evidence of a reduction in the worst types of error resulting in death, albeit with small numbers., Abstract In 2008, the National Patient Safety Agency issued a Rapid Response Report ( RRR) aimed at health-care organisations providing inpatient care for mental health and learning disability patients, requiring organisations to make proper provision for life support and resuscitation for these patients. This paper examines whether effective implementation of the RRR recommendations had occurred across health providers in England. The methods used in this paper are the following: (1) Questionnaires were distributed nationally to clinical staff and implementation leads; (2) A national comparison of the number and severity of pre- and post- RRR release-related incidents involving choking/cardiac/respiratory arrest in Mental Health and Learning Disabilities settings was conducted; (3) Organisational compliance with the patient safety alert for all National Health Service Organisations in England was measured. There were five deaths post-implementation of the RRR that were considered to have serious enough error associated with the resuscitation. This was down from 18 deaths pre the RRR release. Although our survey responses show a contradiction between organisational implementation and clinical staff awareness, our analysis suggests a reduction in moderate and severe harm cases and of deaths. There is evidence of a reduction in the worst types of error resulting in death, albeit with small numbers. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls in Torbay, a community of 131,000 in the southwest of England with a high proportion of older residents, over a two-year period. Design/methodology/approach - The paper analysed patient-level linked acute hospital, community care and local authority-funded social care data to track patients' care costs - for those patients admitted to an acute hospital due to their fall - in the 12 months before and after their fall. Findings - On average, the cost of hospital, community and social care services for each admitted for a fall were almost four times as much in the 12 months after admission, than the cost of the admission itself. Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall. The most dramatic increase was in community health care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs. For patients who had a minor fall and those who survived 12 months after the fall, the costs of care home services increased significantly; for patients with hip fracture, the costs of community care services increased significantly; for patients who did not survive 12 months after the fall, the cost of acute inpatient and community health visits increased significantly. Originality/value - This is the only study that has assessed the costs across the acute hospital, community care and social care pathway for this group of patients, in an English population. This will help commissioners and providers understand and develop better-integrated responses to frail elderly patients needs. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

This research project was designed to enhance the critical thinking and problem-solving skills of practice teachers (PTs) and promote role modelling to specialist community public health nursing (SCPHN) students. This paper explores the impact of action learning sets (ALS) on the trainee PT role and associated students and stakeholders. Pre- and post-intervention surveys were completed by eight trainee PTs and three focus groups were held consisting of trainee PTs, practice education facilitators and students. Three focus groups for the trainee PTs, practice education facilitators and allocated students were held. Findings are presented in relation to three themes: knowledge, skills and role modelling in practice; dedicated practice teacher development; and ALS in practice. Data analysis demonstrated that the PTs valued the dedicated module and ALS enhanced their knowledge and skills. These skills were role modelled to students to guide reflection and knowledge acquisition. All participants intended to develop ALS as part of continued professional development. The paper concludes with recommendations to improve the educational development of both trainee and experienced PTs through the integration of ALS as part of PT development. [ABSTRACT FROM AUTHOR]

Purpose – Relative deprivation is associated with poor mental health but the mechanisms responsible have rarely been studied. The purpose of this paper is to hypothesize that childhood perceived relative deprivation (PRD) would be linked to sub-syndromal psychotic symptoms and poor wellbeing via beliefs about justice, trust and social rank. Design/methodology/approach – In total, 683 undergraduate students were administered measures of childhood PRD, hallucination-proneness, paranoia and wellbeing and measures of trust, social rank and beliefs about justice. A subsample supplied childhood address data. Multiple mediation analysis was used to assess pathways from childhood experiences to outcomes. Findings – Childhood PRD was associated with all three outcomes. The relationship between PRD and paranoia was fully mediated by perceptions that the world is unjust for the self and low social rank. The same variables mediated the relationship between PRD and poor wellbeing. There were no significant mediators of the relationship between PRD and hallucination-proneness. Research limitations/implications – Although our outcome measures have been validated with student samples, it may not be representative. The study is cross-sectional with a retrospective measure of PRD, although similar results were found using childhood addresses to infer objective deprivation. Further studies are required using prospective measures and patient samples. Social implications – Social circumstances that promote feelings of low social worth and injustice may confer risk of poor psychological outcome. Ameliorating these circumstances may improve population mental health. Originality/value – Improvements in public mental health will require an understanding of the mechanisms linking adversity to poor outcomes. This paper explores some probable mechanisms which have hitherto been neglected. [ABSTRACT FROM AUTHOR]

This paper draws on findings from an analysis of interviews with young people aged 14–18 years, to explore the peer influences in young people's informal social networks which can affect their access to sexual health services. The research focuses on the social meanings of a C-Card condom distribution scheme in North East England. Such schemes are widespread in the UK as a way of providing access to condoms and sexual health advice for young people in health and community settings. Focusing on one aspect of a broader study, the paper outlines the important social, emotional and practical resources provided by young people's chosen friendship groups in the process of acquiring a C-Card, which offers a route to accessing sex and relationships advice and condoms. Informal peer networks inform attitudes and expectations which can influence gendered patterns of behaviour. Through a focus on the educational possibilities of the C-Card scheme, the study suggests a need to revisit the dynamics of young people's peer relationships and harness their potential to influence sexual attitudes and behaviour in positive ways, rather than simply seeing these always as a source of negative pressure. [ABSTRACT FROM AUTHOR]

Objective: This paper is a report of the findings from a research project designed to explore complementary and alternative medicines (CAM) activity among a group of childbearing women in the north of England. Method: A descriptive questionnaire survey was designed to explore CAM activity with a sample (distributed to 85 women, of which 40 responded). Ethical approval was obtained from the NHS trust and the University of Hull. Findings: Questionnaire data revealed that 17 out of 40 women (42.5%) engaged with CAM. A total of 11 (27.5%) had been offered CAM as part of their routine NHS care. Seven women (17.5%) used CAM after suggestion from a midwife, five (12.5%) used CAM by personal choice, and three (7.5%) had been encouraged by a friend or relative or 'another source' to use a form of CAM. In 11 (27.5%) cases, a midwife was aware of the use of CAM. However, four women (10%) stated they did not inform their midwife that they were using CAM. Conclusions: A number of women are engaging with different forms of CAM. NHS provision appears to be fairly accurate in meeting the needs of this group of women. A small proportion of women using CAM are seeking advice from their midwife, and this is concerning. The findings from this preliminary survey present some evidence of a consumer interest in these medicines. The findings reflect the suggestion made by Jones (2012), that midwives in their attempts to promote models of care that seek to focus on a woman-centred and a midwifery-led approach, appear to be 'pseudo consumers' of CAM. Implications: Researchers and practitioners should gain more insight into how women engage with, and want to engage with CAM. Midwifery research needs to effectively engage with the issue of consumer demand, and distinguish this from consumer interest. Further research is required in relation to midwives and their 'pseudo consumer' role of CAM use. There are growing opportunities to design and deliver relatively simple CAM treatments that meet women's needs. Midwives could use the booking interview and antenatal consultations to encourage women who are engaging with such medicines to seek advice from the appropriate CAM practitioner in relation to safety and efficacy. [ABSTRACT FROM AUTHOR]

Abstract: Many patients find using medicines burdensome. This paper reports the types of issues people experience with medicines, using a validated measure of medicines burden, and the factors associated with high burden. The cross‐sectional study involved patients presenting prescriptions at pharmacies or awaiting appointments at GP practices or outpatient clinics, during October 2015 to December 2016. Adults using at least one regular medicine were asked to complete the Living with Medicines Questionnaire V3 (LMQ‐3). The LMQ‐3 contains 41 statements rated on a 5‐point scale (strongly agree to strongly disagree), with higher scores indicating greater burden, plus a visual analogue scale for self‐reporting of overall perceived burden (VAS‐burden). For a subsample, access to their medication record was requested, facilitating calculation of the complexity of their medicine regimen using the Medicine Regimen Complexity Index (MRCI). Of 1,888 questionnaires distributed, 684 were returned (36.2%) and medication records obtained for 163. The median number of medicines respondents reported using was 4 (range 1 to 26). Two‐thirds (418; 67.0%) used medicines more than once daily, 67 (10.1%) required assistance with medicines and 189 (28.3%) paid a prescription charge. LMQ‐3 scores showed a strong positive relationship with VAS‐burden scores (r = .547; p < 0.001). LMQ‐3 and VAS‐burden scores were lower in older age groups, but both increased with increasing number of medicines and dosing frequency. LMQ‐3 score was positively related to MRCI score (n = 163; r = .217; p = 0.005), whereas VAS‐burden was not. Older respondents reported lower burden in most domains. Higher numbers and frequency of medicines, paying prescription charges, needing support and deprivation increased burden across multiple domains. Factors strongly associated with high LMQ‐3 scores were: needing support, high dosing frequency and unemployment. Interventions seeking to reduce medicines burden should consider targeting individuals who need support with using medicines, use at least four medicines, more than twice daily and/or pay prescription charges. [ABSTRACT FROM AUTHOR]

This paper considers the situation of the English voluntary sector in relation to austerity-driven social policies. Existing characterisations are outlined and it is argued that the quantitative evidence used to represent the situation of these organisations to date has been partial because it relies too narrowly on financial resource input measures. We argue that the situation of these organisations needs to be conceptualised in a more holistic way and, to initiate a move in this direction, we identify and explicate two relevant dimensions: the perceived capacity of organisations to rely on volunteers for support (a non-financial resource input); and their perception of the effect of the policy climate in shaping their capacity to flourish, including their ability to perform multiple roles beyond service provision alone. We draw on an original mixed methods empirical study undertaken in England in 2015 to operationalise these dimensions, combining qualitative interviews with national ‘policy community’ members with a large scale on-line survey of social policy charities. We find a complex and variegated situation that, while acknowledging the fundamental importance of financial resource pressures, also points to the salience of the volunteering situation, and to the relevance of the challenging policy climate that these organisations have to navigate. [ABSTRACT FROM AUTHOR]

Purpose Visualising and analysing geographical patterns in mental illness can be a starting point for understanding and creating effective policy around inequalities and how to resolve them. The paper aims to discuss these issues.Design/methodology/approach This research note looks at geographical variations in GP drug prescribing for schizophrenia and similar psychosis using open Presentation-level Data for England downloaded from NHS Digital.Findings The authors found considerable geographical variation in both the level of prescribing per thousand population at local authority level and in the rate of change measured over five years. There is a statistically significant north-south divide in prescribing. The authors have used social marketing geodemographics to explore possible correlates with the geographical patterns. Highest positive correlations show links to deprivation and less healthy lifestyle choices.Originality/value This is the first time National maps of geographical variation of GP prescribing for schizophrenia and psychosis have been produced. Seeing this geographical variation is in itself informative and a potential eye-opener. In doing so, new questions can be asked of the data, practice and policy. [ABSTRACT FROM AUTHOR]

Despite an obvious and growing need, there has historically been scant provision of social care and social work in prisons. Thus, although the 2014 Care Act gave local authorities in England responsibility for identifying, assessing and meeting adult prisoners' social care needs, little was known about the number of prisoners eligible for support, the extent of their needs or how best to meet them. Against this background, this paper reports the findings of two national surveys of local authority managers undertaken in 2016 which found that upwards of 1,800 prisoners with social care needs were identified in the first year, of whom almost 1,600 received an assessment and approaching 800 were deemed eligible for the provision of care and support. Whilst specialist social care staff (primarily social workers) were widely engaged in prisoner assessments, many local authorities had delegated their responsibility for identifying prisoners with social care needs to prison health care staff, and there was considerable variation in the way that social care and support were delivered. A number of implications for social work practice and research were identified, including a need for greater active case finding and further evaluation of the impact of the emerging arrangements on prisoners' outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe a study which explored the knowledge and attitudes of university students towards people living with dementia, and developed and tested a dementia awareness workshop, dementia detectives: university edition, designed to improve knowledge and foster positive attitudes to dementia in students.Design/methodology/approach Dementia detectives: university edition was launched during dementia awareness week and five workshops were delivered to university students. In total, 42 participants attended and completed a knowledge and attitude measure before and after the workshop, as well as rating the workshop with regards to satisfaction, relevance, understanding and whether they would recommend the workshop to friends.Findings Students perceived living with dementia to be a negative and stigmatised experience. The workshop scored highly in terms of satisfaction, relevance and understanding and all students stated that they would recommend the workshop to others. Paired t-tests found significant improvements in self-assessed dementia knowledge.Research limitations/implications This was a pilot evaluation and further testing with larger samples is required.Practical implications The workshop meets the requirements for tier 1 dementia education and training as outlined in the Dementia Core Skills and Knowledge Framework published by the Department of Health.Social implications The workshop has the potential to increase knowledge, change attitudes, improve empathy and contribute to the development of a dementia aware workforce through undergraduate education.Originality/value Dementia detectives: university edition is a novel interactive method of dementia education and training. [ABSTRACT FROM AUTHOR]

This paper explores how social workers can communicate effectively using an interpreter. It examines how child and family practitioners describe their experiences of working with interpreters and uses audio recordings of home visits to analyse how the challenges they describe manifest in practice. The analysis is based on audio recordings of nineteen interpreter-mediated meetings between workers and families, and two focus groups with practitioners. Recordings were categorised using quantitative coding, and data were analysed thematically. Although workers find using an interpreter challenging, in practice, skilled practitioners are able to work effectively providing they adopt an assertive approach. This is characterised by clarifying misunderstandings, involving the client in ‘chit-chat’ to build rapport and, where clients have differing levels of language proficiency, conducting the conversation entirely in the native language. The study demonstrates the centrality of social worker skills in managing interpreter-mediated sessions and improving practice for non-native-speaking families. This has implications for social work practice internationally. [ABSTRACT FROM AUTHOR]

Background Childhood obesity is a serious public health issue. Understanding environmental factors and their contribution to weight gain is important if interventions are to be effective. Aims The purpose of this research was to assess the relationship between weight gain in children and accessibility of fast-food outlets. Methods A longitudinal sample of 1577 children was created using two time points from the National Child Measurement Programme in South Gloucestershire (2006/7 and 2012/13). A spatial analysis was conducted using a weighted accessibility score on the number of fast-food outlets within a 1-km network radius of each child’s residence to quantify access to fast food. Results The mean accessibility score for all children was 0.73 (standard deviation: 1.14). Fast-food outlets were more prevalent in areas of deprivation. A moderate association was found between deprivation score and accessibilty score (r = 0.4, P < 0.01). Children who had greater access to fast-food outlets were more likely (odds ratio = 1.89, P = 0.04) to gain significant weight (>50 percentile points) compared to children who had no access to fast-food outlets. Conclusions This paper supports previous research that fast-food outlets are more prevalent in areas of deprivation and presents new evidence on fast-food outlets as a potential contributor towards weight gain in mid-childhood. [ABSTRACT FROM AUTHOR]

Purpose The provision of telecare for older adults in England is increasingly being facilitated by care navigators in the non-statutory sector. The purpose of this paper is to explore the experiences of care navigators when assessing older adults for telecare and to understand what contextual and organisational factors impact on their practice.Design/methodology/approach A purposeful sample of care navigators and telecare installers was selected. Care navigators were recruited from five non-statutory organisations. In order to provide an insight into telecare provision by this sector, telecare installers were also recruited. Semi-structured interviews were conducted with 11 participants covering: role, training, assessment, reviews, installation, suitability, impact, aims, outcomes, and organisational structure. Interview data were analysed using the framework approach.Findings Five main themes emerged from the analysis: responsiveness, autonomy, knowledge exchange, evolving practice, and sustaining performance.Research limitations/implications This study included a small sample, and was only based in one local authority, focusing on the experience of care navigators in only one sector.Practical implications The findings suggest that strategic placement of care navigators could support the demand for telecare assessment to facilitate discharges from hospital. This study highlights the perception of home assessment as a gold standard of practice for care navigators. In order to develop a more sustainable model for care navigators’ capacity to work within hospital teams and provide home assessments needs further consideration.Originality/value This study is one of the first to explore the role of the care navigator and their involvement in the provision of telecare for older adults. [ABSTRACT FROM AUTHOR]

Purpose Each year approximately 3,200 women have a stillbirth in the UK. Although national evidence-based guidance has existed since 2010, case reviews continue to identify suboptimal clinical care and communication with parents. Inconsistencies in management include induction and management of labour and the frequency of investigation after stillbirth. The paper aims to discuss these issues.Design/methodology/approach An audit of stillbirths was performed in 2014 in 13 maternity units in the North West of England, this confirmed variation in practice described nationally. An integrated care pathway (ICP) was developed from national guidelines to enable optimal care for the management of stillbirth, reduce variation, standardise investigations and coordinate patient-focussed care. This was launched in 2015 and updated in 2016 to resolve the issues that were apparent after implementation.Findings Each participating unit had commenced using the ICP by May 2015. Following implementation there were changes in care, most notably from diverse methods for the induction of labour to guideline-directed induction of labour. There were trends towards better care in terms of information given, choices offered, more appropriate analgesia in labour and improved post-delivery investigation for cause. Staff feedback about the ICP was positive.Practical implications The use of this ICP improved care for women who had a stillbirth and their families. Issues with implementing a changed care pathway meant that further iterations were required, ongoing improvement is expected following the refinement of the ICP.Originality/value ICPs have been used for various clinical conditions. However, this is the first example of their use in women who had a stillbirth. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.Design/methodology/approach Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.Findings While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.Research limitations/implications There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.Practical implications While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.Originality/value Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report how an evaluation tool originally developed for Age-Friendly Cities was pilot-tested in the context of the Dementia Friendly Community (DFC) initiative of the city of Sheffield/UK. It presents finding and outputs on which other communities with dementia friendly agendas can draw.Design/methodology/approach The original evaluation tool was adapted to a focus on dementia friendliness. Data collection involved scoping conversations, documentary analysis, interviews and group discussions. Following evidence appraisal, Sheffield’s approach to dementia friendliness was assessed. A local steering group was central to the study.Findings The evidence indicates areas of strength in Sheffield’s approach to dementia friendliness: involvement of older people; service provision; collaboration; monitoring and evaluation. Scope for improvement was identified around resource allocation, and use of existing guidance on dementia friendliness. Recommendations for policy and practice include enhancing pooling of resources, more detailed recording of resources allocated to dementia-related activity, and collection of evidence on how people affected by dementia have shaped the city’s DFC initiative. Key research outputs are an adaptable logic model and an emerging evaluation framework for DFCs.Research limitations/implications The study was a short pilot with limited resources. Its findings and outputs must be considered preliminary.Originality/value The findings and outputs provide a basis for further research. The study has suggested key components of an evaluation framework for DFCs. It is informing ongoing work to develop such a framework. [ABSTRACT FROM AUTHOR]

Purpose The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes.Design/methodology/approach This fidelity of implementation (FoI) study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence.Findings Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings.Originality/value An appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development. [ABSTRACT FROM AUTHOR]

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity. • The non-patient-facing work of general practitioners is often invisible or hidden. • Hidden work is associated with complexity and uncertainty. • Behind-the-scenes work is care work, just as direct work with patients is care work. • Doctors face tensions between completing tasks and working a manageable day. • Combining practice theory with the Listening Guide embraces multi-vocality. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore multidisciplinary attitudes and environmental factors affecting dementia care in the Cardiac Catheter Laboratory (CCL).Design/methodology/approach Questionnaires (n=87) were distributed in a hospital CCL in the North of England. The authors utilised the Dementia Attitudes Scale which incorporates two subscales: Social Comfort and Dementia Knowledge. In addition, a newly devised questionnaire asking about perceptions of how the CCL environment affected care of patients with dementia was added.Findings The response rate was 71 per cent (n=62). Years’ experience in the CCL was associated with lower Social Comfort scores (p=0.026). Dementia training was associated with higher mean Dementia Attitudes Scale and Social Comfort scores (p=0.021, p=0.007). Participants who had undertaken “Professional studies” had higher Dementia Attitudes Scale and Dementia Knowledge mean scores (p=0.038, p=0.046) but “On-the-job” training was perceived as most beneficial (32 per cent, n=20). Unit co-ordinators and nurses felt the CCL was an unfavourable environment for patients with dementia. Care was perceived to be impaired by environmental functionality, equipment and the presence of ionising radiation.Research limitations/implications The small sample limits generalisability. Although the Dementia Attitudes Scale is a validated questionnaire it has not been widely used so reliability of these results is unclear.Practical implications Caring for patients with dementia has unique challenges especially in areas like the CCL. These results suggest that practical experience and training can affect the perception of staff to patients with dementia hence there may be a need to assess what would be the most appropriate training to give health professionals in the future.Originality/value The authors believe this to be the first multi-professional research study into care of patients with dementia in a specialised acute unit. This was the most diverse sample known to have attitudes to dementia measured quantitatively in an acute hospital department and the results need to be replicated before practice should be changed. [ABSTRACT FROM AUTHOR]

This article analyses the interaction between two policy areas affecting young people in England – housing and student funding. It is the first of its kind exploring a range of dynamics in the relationship between housing and student loan debt. Young people today are far less likely to own their home and are more likely to live with their parents than earlier generations. In parallel, higher education tuition fee increases have led to a growing share of students taking out loans and graduating with higher debt, which they will be repaying for most of their working lives. This research examines the relationship between student loans – having borrowed for higher education and attitudes towards debt – and housing tenure at age 25, using the Next Steps dataset. We find that young graduates who did not borrow for higher education are more likely to own their home and less likely to rent or live with their parents than graduates who borrowed for their studies or young people who never attended higher education. These results suggest that higher education funding policies and student loan debt play important roles in structuring young people's housing in England. [ABSTRACT FROM AUTHOR]

Although the long-term consequences of informal care provision have been well investigated, few studies have examined the trajectories of informal care provision among older people and the socioeconomic, demographic, health, and family characteristics associated with them. We use data from four waves of the English Longitudinal Study of Ageing, with 6561 respondents followed for 6 years (2012/3–2018/9). We used group-based trajectory modelling to group people's provision of care over time into a finite number of distinct trajectories of caregiving. Using multinomial logistic regressions, we then investigated the characteristics associated with these trajectories. Four distinct trajectories of caregiving were identified: "stable intensive", "increasing intensive", "decreasing", and "stable no care". Results suggest that although there are socioeconomic, demographic, and health differences across the trajectories of caregiving (with younger women in good health and poorer socioeconomic status more likely to care intensively throughout), family characteristics are their main drivers. Respondents who live alone, with no children, and no parents alive are more likely to never provide care, whereas those with older parents and who live with adults in poor health are more likely to provide stable intensive care. Also, changes in family characteristics (e.g. death of parents, widowhood, or deterioration of the partner's health) are associated with trajectories representing increases or decreases in caregiving over time. Overall, trajectories of informal caregiving undertaken by older people are varied and these patterns are mostly associated with both the availability and health of family members, suggesting that need factors represent the most immediate reason for caregiving commitments. [ABSTRACT FROM AUTHOR]

Background: Children in care and care leavers have worse health outcomes than their peers without care experience. This study addresses an evidence gap in exploring care-experienced young people's views and experiences of accessing general practice and dental services and attending health reviews in England. Methods: We conducted a qualitative study using podcasting as a creative medium. We recruited young people from two sites: one in South England (A) and one in greater London (B). We held two paired discussions in site A and two focus groups in site B, with 14 participants in total. Participants were aged between 13 and 22 years and were diverse in gender, ethnicity, and care experiences. Data were analysed thematically using candidacy theory as a theoretical framework. Results: Mental health was a prevailing concern for participants, but general practice was not considered a place to discuss it. Most participants reported distant relationships with primary healthcare professionals and considered opening-up to a professional to be risky, for example, it could result in an unknown/unwanted outcome. A lack of time and personal connection in appointments, and experiences of feeling judged, dismissed, or misunderstood, hindered young people's ability to disclose mental health or relationship concerns. Participants reported variation in the timeliness and location of services, with salient examples of extensive waiting periods for braces. Participants perceived annual health reviews to be largely inconsequential. Conclusions: Any primary care presentation by a care-experienced young person should trigger additional professional curiosity. To build rapport and trust, professionals should not underestimate the power of active listening, being reliable and honest, and small acts of thoughtfulness, for example, ensuring medical letters are provided promptly. Carers and other trusted professionals should help care-experienced young people to understand the role of primary care and support them with access. Health reviews may not be of value to all young people in care. Further research is needed to examine primary healthcare access for care-experienced young people with significant safeguarding and healthcare needs. [ABSTRACT FROM AUTHOR]

Aims and Objectives: We sought to gain an understanding of the patient experience during their hospital stay for COVID‐19, and the impact of COVID‐19 on quality of life post discharge. Background: Symptoms of COVID‐19 include a persistent cough, dyspnoea and fatigue. Individuals with comorbidities such as cardiovascular disease have a higher risk of contracting COVID‐19 and approximately 20% of those diagnosed with COVID‐19 are admitted to hospital. Following discharge from hospital, 40% of patients report a worsened quality of life and up to 87% of those discharged from hospital have experienced 'long COVID'. Design: A qualitative design was used to understand patient experience of hospitalisation following a diagnosis of COVID‐19, and their experiences following discharge from hospital. Methods: Ten patients with a previous diagnosis of COVID‐19 took part in semi‐structured interviews regarding their experiences of hospitalisation and the impact on quality of life post‐discharge. Results: The results identified three key themes from the interviews: communication and the inpatient experience, symptoms following discharge and regaining independence. Patients discussed their experience of hospitalisation and how this continued to impact their emotional well‐being post‐discharge. However, patients appeared to push themselves physically to improve their health, despite continued COVID‐19 symptoms. Conclusion: Patients hospitalised following a diagnosis of COVID‐19 experienced psychological distress during their hospital stay, as well as 3‐months post‐discharge. We suggest the use of psychosocial interventions to support patients post‐discharge. Relevance to Clinical Practice: The results of this study provide a greater understanding of the patient experience during their hospital stay, which can support nursing staff practice. Additionally, the study provides in depth knowledge of personal experiences of patients diagnosed with COVID‐19 and the impact following hospital discharge. Patient or Public Contribution: Patient's took part in semi‐structured interviews via telephone to support the aims and objectives of this study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications. Background: Confirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X‐rays and missed enteral nutrition and/or medications. Design: Prospective observational study using STROBE checklist. Methods: Data collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X‐rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability. Results: Of 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X‐rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication. Conclusion: Ongoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one‐fifth of patients required X‐rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition. Relevance to Clinical Practice: Caution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing. [ABSTRACT FROM AUTHOR]

The Nursing and Midwifery Council changed its standards in 2018 regarding student learning and assessment on placements. Previously, students were allocated a mentor with whom they spent at least 40% of their time and who also assessed them; the new standards brought in the separate roles of practice supervisor and a practice assessor and abolished the 40% minimum, with the student being supported by a wider range of practitioners. While extensive literature examines the experiences of qualified staff supporting students, there is little evidence on the student experience. A qualitative approach using semi-structured interviews with student nurses from two universities in the south of England was used to explore their experiences. The students reported benefits of being supported by the wider healthcare team, said being taught and assessed by different people was beneficial and that they felt better prepared for assessments. [ABSTRACT FROM AUTHOR]

Increasing frailty or a medical crisis threatens older people's autonomy. Further threats may arise from adult children if such changes or events are perceived as permitting or signalling a need to assume greater control over their parent's life. In the context of reablement—a time‐limited intervention seeking to help older people regain their confidence and ability to live as independently as possible—this is observed in cases where adult children resist, or seek to sabotage, reablement. This runs counter to the notion of family being a valuable resource and partner to reablement services in achieving the desired outcomes. Notions of autonomy and legitimate authority, which often co‐occur in care relationships, provide a useful lens to understand this phenomenon. The aims of this study were to explore reablement staff's accounts of the ways adult children seek to assume control over their parents' reablement, and how they manage such situations. We undertook a secondary analysis of a qualitative dataset comprising transcripts of 11 focus groups with staff (n = 78) in five reablement services in England and Wales conducted for the purposes of a study investigating the factors affecting older people's engagement with reablement. Staff's accounts included descriptions of the different ways adult children can seek to exert control over the reablement process. Staff believed that, when aware this was happening, older people ceded control to their child(ren) because preserving the relationship with their child(ren) was a greater priority than maximising their independence. Staff's descriptions of the different strategies they used to protect family relationships whilst supporting the older person's autonomy shed light on the skills reablement staff require. Findings support person‐centred approaches to reablement which understand and respond to the wider family context. They also point to possible limitations or gaps in workforce training and supervision. [ABSTRACT FROM AUTHOR]

Introduction: This work describes a secondary analysis of a qualitative data set originally used to understand parent participants' preferences for the design and implementation of a screening programme for paediatric Type 1 diabetes (T1D). From this, their spontaneous preferences for peer support emerged, described here in the context of existing peer support programmes for the newly diagnosed alongside suggestions for their incorporation into screening programmes for T1D and a range of other conditions. Methods: Data were collected from semi‐structured interviews conducted with parents of children aged 3–13 years to explore their expectations, perceptions and preferences of a T1D paediatric screening programme. A secondary analysis of interviews from participants who spontaneously raised preferences for peer support was used to populate a novel framework informed by NHS England's key principles for the same, namely, Shared experiences and reciprocated support, Accessibility and inclusivity and Person‐centred and integrated peer support. Results: Parents in 29 of 33 interviews spontaneously described the potential value of peer support if receiving a result indicating a positive (presymptomatic T1D result) from a screening programme. Specifically, the value of 'Shared experiences and reciprocated support' in terms of emotional support and reassurance, and access to more directly interpretable and relevant information related to the condition; 'Accessibility and inclusivity' relating to access to a community of similar individuals, whether in person or online; 'Person‐centred and integrated peer‐support' and the need for support reflecting the changing need of the child and the integration of peer support with clinical care. Conclusions: The needs of peer support described by parents involved in T1D paediatric screening appear to be shared with those of families with children diagnosed with a range of life‐altering conditions. Although the needs of peer support for paediatric screening may differ across conditions, our findings are a valuable starting point for its design both in T1D and other examples of similar population screening programmes. Patient or Public Contribution: Patients and the public have been involved throughout the design of the ELSA study and have worked with us to inform the study process. They contributed to the design and content of patient‐facing materials, the content of our topic guides and the analysis and interpretation of our findings. [ABSTRACT FROM AUTHOR]

Background: Bowel cancer screening using faecal immunochemical testing is provided in the United Kingdom with the aim of reducing mortality from colorectal cancer. However, there are low participant rates among ethnic minorities across the United Kingdom. Faith‐placed interventions have the potential to improve screening rates among such populations, but studies examining their effectiveness are scarce. Methods: We delivered a presentation on bowel cancer screening to 204 Muslims in seven mosques in East London (intervention group). All participants completed a questionnaire regarding attitudes, perceptions and knowledge of bowel cancer screening before and after the presentation. Concurrently, we administered the questionnaire to 72 subjects attending a mosque that did not receive the presentation (comparison group). Results: The intervention group showed a greater willingness to do the test (90% vs. 67%, p < 0.001) and to recommend it to others (96% vs. 74%, p < 0.001), ability to complete the test by themselves (94% vs. 56%, p < 0.001) and confidence in noticing symptoms (78% vs. 32%, p < 0.001) after the presentation compared to before. There was a significant difference between the intervention group post‐presentation and the comparison group on intention to do the test (90% vs. 79%, p = 0.02), recommending it to others (96% vs. 83%, p < 0.001), and confidence in their ability to complete the test by themselves (94% vs. 63%, p < 0.001). Conclusion: A culture‐sensitive, faith‐placed health education intervention delivered in mosques can substantially improve knowledge of bowel cancer screening and increase the intention to participate in the screening programme. Patient or Public Contribution: The intervention presentation was developed using insights from four public involvement sessions with four to six members representative of the East London Muslim community. The sessions sought attendees' thoughts on appropriate ways to approach the intervention design for their community and asked for their views on the acceptability, appropriateness of messaging, format/design and likely impact of the presentation. Their views were then utilised to improve the presentation. [ABSTRACT FROM AUTHOR]

Background: Current research has identified how ethnic minority women experience poorer health outcomes during the perinatal period. In the United Kingdom, specialist perinatal mental health services provide mental health treatment for women throughout the perinatal period. Service users have previously highlighted that perinatal services are hard to access and lack cultural sensitivity, whereas healthcare professionals have described limited opportunities and resources for developing cultural competency. Objectives: We explored the experiences of ethnic minority women with National Health Service (NHS) specialist perinatal teams and identified what culturally sensitive perinatal mental health care means to this group. Design: Individual semi‐structured interviews were conducted, and an interpretative phenomenological analysis framework was used to analyse the interview transcripts. Setting and Participants: Participants were recruited from NHS specialist perinatal teams and online via social media. Results: Six women were interviewed. Four group experiential themes central to the experiences of participants emerged: (1) strengthening community networks and peer support; (2) valuing cultural curiosity; (3) making sense of how culture, ethnicity, race and racism impact mental health; and (4) tailoring interventions to ethnic minority women and their families. Discussion and Conclusions: The findings capture how ethnic minority women experience specialist perinatal teams and offer insights into practising culturally sensitive care. Perinatal mental health professionals can support ethnic minority women by strengthening their access to community resources and peer support; being curious about their culture; helping them to make sense of how culture, ethnicity, race and mental health interact; and applying cultural and practical adaptations to interventions. Patient or Public Contribution: A Lived Experience Advisory Group (LEAG) of women from ethnic minority groups contributed to the design and conduct of this study. The LEAG had lived experience of perinatal mental health conditions and accessing specialist perinatal teams. The LEAG chose to co‐produce specific aspects of the research they felt fit with their skills and available time throughout five group sessions. These aspects included developing the interview topic guide, a structure for debriefing participants and advising on the social media recruitment strategy. [ABSTRACT FROM AUTHOR]

Introduction: The adoption of remote healthcare methods has been accelerated by the COVID‐19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID‐19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. Methods: This was a mixed‐methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. Findings: Survey responses were received from 292 staff and 1069 patients and carers. Twenty‐three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring. Conclusion: Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care. Patient or Public Contribution: The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript. [ABSTRACT FROM AUTHOR]

Background: We assessed experiences of human papillomavirus (HPV) vaginal self‐sampling and future screening preferences in an ethnically and socio‐economically diverse group of women overdue for cervical screening. Setting and Participants: A postal questionnaire was embedded in the YouScreen self‐sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non‐completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow‐up test if HPV‐positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self‐sampling. Results: Most kit‐completers reported high confidence in self‐sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free‐text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self‐sampling in the future (71.3% vs. 10.4% for a clinician‐taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self‐tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. Conclusions: Kit‐completers were confident, found the test easy to complete, and trusted the self‐sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self‐sampling in the future, but it was not a universal preference, so offering a choice will be important. Patient or Public Contribution: We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). Trial Registration: This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934. [ABSTRACT FROM AUTHOR]

Background During the 1997–2010 Labour government, several policies were implemented to narrow health inequalities as part of a national health inequalities strategy. Many of these policies are likely to have had a disproportionately large impact on people aged 65 and over. We aimed to understand the association between the health inequalities strategy period and inequalities in mortality at age 65–69. Methods We use population at risk and mortality data covering 1991–2019 to calculate mortality rate at age 65–69 at the Local Authority level. We use the 2019 Index of Multiple Deprivation to examine geographical inequalities. We employ segmented linear regression models with marginal spline terms for the strategy period and interact these with an indicator of deprivation to understand how inequalities changed before, during and after the strategy. The reporting of this study adheres to STROBE guidelines. Results Mortality rates in each deprivation quintile improved continuously throughout the period of study. Prior to the programme (1991–9) there was no significant change in absolute inequalities. However, during the strategy (2000–10) there was a significant decrease in absolute inequalities of −9.66 (−17.48 to −1.84). The period following the strategy (2011–19) was associated with a significant increase in absolute inequalities of 12.84 (6.60 to 19.08). Our results were robust to a range of sensitivity tests. Conclusion The English health inequalities strategy was associated with a significant reduction in absolute inequality in mortality age 65–69. Future strategies to address inequalities in ageing populations may benefit from adopting a similar approach. [ABSTRACT FROM AUTHOR]

We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children's families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the quality of information recorded in Behaviour Monitoring Charts (BMC) for Behaviours that Challenge (BtC) in dementia in an older adult inpatient dementia service in the North of England (Aim I) and to understand staff perceptions and experiences of completing BMC for BtC in dementia (Aim II). Design/methodology/approach: Descriptive statistics and graphs were used to analyse and interpret quantitative data gathered from BMC (Aim I) and Likert-scale survey responses (Aim II). Thematic analysis (Braun and Clarke, 2006) was used to analyse and interpret qualitative data collected from responses to open-ended survey questions and, separately, focus group discussions (Aim II). Findings: Analysis of the BMCs revealed that some of the data recorded relating to antecedents, behaviours and consequences lacked richness and used vague language (i.e. gave reassurance), which limited its clinical utility. Overall, participants and respondents found BMC to be problematic. For them, completing BMCs were not viewed as worthwhile, the processes that followed their completion were unclear, and they left staff feeling disempowered in the systemic hierarchy of an inpatient setting. Originality/value: Functional analysis of BMC helps identify and inform appropriately tailored interventions for BtC in dementia. Understanding how BMCs are used and how staff perceive BMC provides a unique opportunity to improve them. Improving BMC will support better functional analysis of BtC, thus allowing for more tailored interventions to meet the needs of people with dementia. [ABSTRACT FROM AUTHOR]

Child protection systems monitoring is key to ensuring children's wellbeing. In England, monitoring is rooted in onsite inspection, culminating in judgements ranging from 'outstanding' to 'inadequate'. But inspection may carry unintended consequences where child protection systems are weak. One potential consequence is increased child welfare intervention rates. In this longitudinal ecological study of local authorities in England, we used Poisson mixed-effects regression models to assess whether child welfare intervention rates are higher in an inspection year, whether this is driven by inspection judgement, and whether more deprived areas experience different rates for a given inspection judgement. We investigated the impact of inspection on care entry, Child Protection Plan-initiation, and child-in-need status. We found that inspection was associated with a rise in rates across the spectrum of interventions. Worse judgements yielded higher rates. Inspection may also exacerbate existing inequalities. Unlike less deprived areas, more deprived areas judged inadequate did not experience an increase in the less intrusive 'child-in-need' interventions. Our findings suggest that a narrow focus on social work practice is unlikely to address weaknesses in the child protection system. Child protection systems monitoring should be guided by a holistic model of systems improvement, encompassing the socioeconomic determinants of quality. [ABSTRACT FROM AUTHOR]

Purpose: The current study aimed to examine the population of girls in two secure children's homes (SCHs) in the North East of England to consider the impact of menstruation on girls' physical, mental and emotional wellbeing within secure settings. Gender-responsive approaches and understanding gender differences are central to trauma-informed provision within the Children and Young People Secure Estate (CYPSE). Whilst trauma-informed approaches are central, it could be argued that basic gender differences, such as the menstrual cycle, are currently being overlooked within research and practice. Design/methodology/approach: A case file audit examined documentation of 24 girls who were admitted across both sites between January 2022 and January 2023. Findings: Of the sample (n = 24), 50% had information recorded regarding their menstrual cycle during admission assessments. Six girls (25%) disclosed experiencing irregular menstruation. Painful cramping was noted by two girls (8%). One girl (4%) disclosed heavy bleeding, and menorrhagia (abnormal heavy bleeding) was reported for one further girl (4%). One girl (4%) disclosed early onset menarche. Case formulations tended to focus less on girls' menstrual cycles or the potential impact of this on wellbeing. However, 100% of case formulations considered the potential impact of trauma and/or disrupted attachment on girls' presentations. Originality/value: The results indicate the impact of menstrual cycles on girls' physical, mental and emotional wellbeing may benefit from much further consideration. Implications are presented alongside directions for future research. [ABSTRACT FROM AUTHOR]

Background: In 2022, England embarked on an ambitious and innovative re-organisation to produce an integrated health and care system with a greater focus on improving population health. This study aimed to understand how nascent ICSs are developing and to identify the key challenges and enablers to integration. Methods: Four ICSs participated in the study between November 2021 and May 2022. Semi-structured interviews with system leaders (n = 67) from health, social and voluntary care as well as representatives of local communities were held. A thematic framework approach supported by Leutz's five laws of integration framework was used to analyse the data. Results: The benefits of ICSs include enhancing the delivery of good quality care, improving population health and providing more person-centred care in the community. However, differences between health and social care such as accountability, organisational/professional cultures, risks of duplicating efforts, tensions over funding allocation, issues of data integration and struggles in engaging local communities threaten to hamper integration. Conclusions: Despite ICS's investing in the structural and relational components of integrated care, the unprecedented pressures on systems to reduce demand on primary and emergency care tackling elective backlogs may detract from a key goal of ICSs, improving population health and prevention. [ABSTRACT FROM AUTHOR]

Purpose: School social work, in various forms, is well established internationally and has a growing evidence base. Yet existing research focuses on professional perspectives rather than those of students. This study aims to fill this gap by exploring secondary school student perspectives of having social workers in schools (SWIS). It was undertaken in England as part of the SWIS trial, which tested whether secondary school-based social workers could improve child safety and well-being, identify issues more quickly and reduce the need for statutory services. Design/methodology/approach: A mixed-methods approach comprised a survey (n = 1,998 students) and interviews (n = 27 students). Surveys included questions on awareness, understanding, interaction with and attitudes towards the school-based social workers. Interviews involved a Q-sort activity followed by semi-structured questions on general attitudes and experiences. The Q-sort characterised prominent perspectives and how many students subscribed to them. Findings: Students were broadly positive about having a social worker in their school in the survey and interviews. Two prominent perspectives on SWIS were identified. The first (n = 17) was defined by students feeling positively overall and strongly agreeing that they trusted the social worker. The second (n = 4) was mixed in sentiment, defined by some anxiety about working with the social worker. In interviews, students relayed that social workers were easily accessible, offered emotional support and acted as a bridge between school and home. Originality/value: To the best of the authors' knowledge, this study is the first to quantify student perspectives on having social workers at school and evidence attitudes and experiences about school-based social work as practiced during the SWIS trial. [ABSTRACT FROM AUTHOR]

Background: Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice. Aim: To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding. Design & setting: A systematic review of prescribing formularies in England and Wales. Method: A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021–22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs. Results: Seventy-four prescribing formularies were reviewed. Of these, 14.9% (n = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (n = 21/74) provided links to guidance on PPH risk, and 1.4% (n = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (n = 9/74), 23.0% (n = 17/74), and 21.6% (n = 16/74) of formularies, respectively. Conclusion: Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure. [ABSTRACT FROM AUTHOR]