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This article describes the key findings of a study which critically analyses the construction of social class within UK media during the period 2010–2016 – part of the 'age of austerity'. Focusing upon 240 newspaper articles covering six topics (emergency budget, welfare reform, workfare, bedroom tax, food banks and zero-hour contracts), the study provides critical insights into how class is constructed in an important context: namely that of economic downturn and rising inequality. The findings suggest that a pro-austerity discourse dominates the coverage. Here austerity is described as necessary, and the idea of 'unavoidable scarcity' forms the basis for a 'moral divide' between a vague in-group – the 'ordinary hardworking people', defined by their idealised struggle and selfless sense of duty – and an exploitative 'other'. This both legitimises austerity and masks its broader impact. As the impacts become more apparent, however, challenges to the dominant narrative begin to appear. In the course of these challenges, the struggle inherent to class is placed back on the agenda, and class is increasingly constructed as an 'anxious concept' – a slippery slope down which one might fall. [ABSTRACT FROM AUTHOR]

Universities face an uncertain funding environment and turbulent marketplace. Financial scenario modelling offers a potential mechanism to assist in navigating a way forward. Our previous paper on UK universities' practice found some variation in the sophistication of the approaches taken, but the overall impression was of a relatively simple approach, with spreadsheets generally viewed as having sufficient functionality to meet current strategic needs. This subsequent paper offers guidance on the construction of financial scenario models. It addresses the key variables that universities may wish to include, and it offers advice on how models might be formulated and evolve. The characteristics of differing approaches taken by universities in meeting their own scenario modelling requirements are explored by identifying three forms of model: basic, intermediate and advanced. The contribution of this paper is to enable universities, in the UK and beyond, to evaluate and improve their own financial scenario modelling practices. [ABSTRACT FROM AUTHOR]

This paper dwells on the account, provided by de Cecco, of the functioning of the international gold standard, as steered by Great Britain. The arrangement relied on a few institutional aspects dealing with the acquisition and disposal of gold by Britain, not only as units of transactions but also to facilitate profitable investments overseas. India had a major role in providing gold flows, as political tributes, to meet the 'Home Charges' in the ruling country. Nationalist arguments in India on the 'drain' were centred on the legitimacy of using taxes in India to meet the overseas expenditure in Sterling. Further sources of financial transfers, were not recognised by the nationalists. This paper provides an outline of the multiple channels of transfers used to expropriate gold from India. Those routes include India's trade surpluses; 'expenditure abroad' as earmarked in the domestic budget; currency reserves; and the camouflaging of unproductive debts by Britain to justify the interest payments under Home Charges. This is a new interpretation of the mode and the magnitude of financial expropriations by Britain, supplementing the 'Drain of Wealth' narrative. The paper ends comparing the colonial expropriations from India and the subordinate finance in the neo-colonies under contemporary capitalism. [ABSTRACT FROM AUTHOR]

This article places the Office for Budget Responsibility's commentary on the March 2023 UK Budget in political context. It explores how increased independent expert input has transformed the UK economic policy regime, focussing on the complex relationship between rules‐based economic governance, independent oversight and fiscal discipline. The technocratic veneer that enshrines the UK fiscal watchdog obscures the inevitable politics of rules‐based fiscal governance. The recent budget revealed OBR scepticism about how far budget measures can address the UK economy's long‐term structural weaknesses. This underlined the key role for judgment inherent within technocratic fiscal oversight. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HCAIs) pose a significant threat to the health and safety of patients, staff, and visitors. Infection prevention and control (IPC) teams play a crucial role in ensuring that systems and processes are in place to keep everyone safe within the healthcare environment. Aim: The aim of this study was to identify components of infection prevention services, priorities, indicators of successes and how they are measured, and facilitators and barriers to success. Methods: A s urvey questionnaire was developed and circulated to infection prevention leaders and managers. Findings/results: Seventy IPC leaders/managers completed the survey. Participants were responsible for a range of IPC services within and across healthcare organisations, with significant variations to IPC delivery components. Additionally, a range of budget availability was reported. Several IPC service requirements were considered core work of IPC teams, including providing IPC advice and support, surveillance and audit and education and training. Discussion: An optimal IPC service needs to be in place to ensure HCAIs are minimised or prevented. In a post pandemic era, this is more important than ever before. This is also as crucial for the health and wellbeing of those working in IPC, who have endured unprecedented demand for their services during the pandemic. [ABSTRACT FROM AUTHOR]

This article compares the pharmaceutical pricing policies employed by public and private insurers in the United States with seven price and spending control strategies employed in the United Kingdom, France, and Germany. Differences between American and European policies explain why American pharmaceutical prices and per capita spending are higher than in European nations. The article then analyzes two recent bills as examples of significant American reform ideas--H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (introduced in 2019) and the Build Back Better Act (BBBA, introduced in 2021)--and compares them with European cost control strategies. Key drug price provisions of the BBBA were incorporated into the recently enacted Inflation Reduction Act (IRA). H.R. 3 would have used an international (mostly European) price index to cap U.S. prices, the BBBA would cap Medicare prices at a discount from average U.S. market prices. Neither bill would employ the key cost control strategies that European nations do. Both bills would have significantly less impact on prices than legislation that employs European-style cost controls. This article proposes steps that Congress could take in line with European strategies to lower purchase prices and costs for patients. These measures would have to overcome political obstacles that currently stymie reform. [ABSTRACT FROM AUTHOR]

The heritage sector, and more specifically the growing list of buildings at risk across the UK, presents wide-ranging changes to owners, heritage bodies, potential funders, consultants and specialist advisers and contractors. When protected buildings and heritage assets reach an advanced state of decay the challenges escalate, and as solutions are sought the problems also escalate, with costs spiralling. Remedial works' costs and budgets are often difficult to quantify, which in turn creates challenges for both funding and procurement, where cost certainty and low risk is desired. The solution requires clear thinking and objectives that are achievable. In many cases 'grand aspirations' fail to get off the ground, becoming too wide-ranging in their aims. With heritage at risk, the extent of unknown works is often extensive and difficult to fully quantify until works are in progress. This never sits comfortably with funders and can be the vicious circle of unknown work, unknown cost, that prevents projects starting. Effective experienced project teams are not engaged sufficiently early to contribute to the strategies. The need for realistic practical options that can be implemented efficiently and promptly requires collaboration from a wide range of sources. Bringing together clients, funders, consultants, contractors and statutory heritage bodies in a spirit of collaboration and common objectives is at the heart of a successful project; this enables works and cost control to be effectively managed, and most importantly allows works to start and the cycle of decay and decline to be halted. This case study shows how a committed local council secured funding and assembled a team of advisers, consultants and contractors to bring a significant heritage-at-risk asset back from the brink of collapse, demonstrating how trust in collaborative working exceeded all expectations and delivered additional stabilisation works within the available funding. [ABSTRACT FROM AUTHOR]

This article extends the project-engineering management/post-audit literature into the field of business ethics and board gender diversity. As a result, it fills an important gap in the literature. Board gender diversity is an important issue with ramifications on corporate decision-making. Based on a sample of 163 UK small-medium enterprises (SMEs), our research shows differences between gender diverse (GD) boards and male-only boards in post-audit (P-A) practices. GD boards conduct more post-audits and adopt a more formal approach to post-audit procedures. There are significant differences between the two board types concerning the reasons for undertaking post-audits and the non-adoption of post-audits (P-As). An interesting observation is in the area of risk aversion, as we find an inconsistency between those SMEs that conduct P-As and those that do not. This inconsistency may reflect the earlier literature, which is inconclusive in its findings concerning females' attitudes to risk. A further interesting observation from the data analysis shows that GD Boards appear to be more focused, while male boards are more diverse in their responses. This article is of relevance and general interest to engineering economists in an investment appraisal, P-A, project management, and governance environment, fostering diversity and equality in regulating corporate activities, assisting practitioners and policy-makers in understanding the importance of monitoring capital projects, and the role played by gender-diverse boards. [ABSTRACT FROM AUTHOR]

Goodfellow's tree kangaroos (Dendrolagus goodfellowi) are an endangered, arboreal macropod native to the lower, mid-montane rainforests of Papua New Guinea. Despite a number of holders keeping D. goodfellowi in zoos across the world, there is a lack of recent published work on this species. Here, we present daytime activity budgets, document height use and provide husbandry information for two Goodfellow's tree kangaroos (Dendrolagus goodfellowi buergersi) housed at Chester Zoo, UK. Throughout the observation period, both individuals spent the majority of their time resting within the environment but also spent time engaging in vigilance, travel and feeding behaviour. Additionally, despite the age and sex differences of the study individuals, both animals used the highest height level in the indoor habitat most frequently. We aim to share our information and encourage knowledge transfer with other holders, to both increase understanding and promote evidence-based management of this species. [ABSTRACT FROM AUTHOR]

Opposition to Universal Basic Income (UBI) is encapsulated by Martinelli's claim that 'an affordable basic income would be inadequate, and an adequate basic income would be unaffordable'. In this article, we present a model of health impact that transforms that assumption. We argue that UBI can affect higher level social determinants of health down to individual determinants of health and on to improvements in public health that lead to a number of economic returns on investment. Given that no trial has been designed and deployed with that impact in mind, we present a methodological framework for assessing prospective costs and returns on investment through modelling to make the case for that trial. We begin by outlining the pathways to health in our model of change in order to present criteria for establishing the size of transfer capable of promoting health. We then consider approaches to calculating cost in a UK context to estimate budgetary burdens that need to be met by the state. Next, we suggest means of modelling the prospective impact of UBI on health before asserting means of costing that impact, using a microsimulation approach. We then outline a set of fiscal options for funding any shortfall in returns. Finally, we suggest that fiscal strategy can be designed specifically with health impact in mind by modelling the impact of reform on health and feeding that data cyclically back into tax transfer module of the microsimulation. [ABSTRACT FROM AUTHOR]

Background: Despite substantial investment in step-free access at UK railway stations, persons with reduced mobility (PRMs) continue to travel less than their able-bodied counterparts and little is known about the value of step-free access. This research examines the benefits of step-free access and its relationship with rail usage among PRMs, and the wider benefits of railway station accessibility. Methods: These issues are explored through a mixed methods approach. Semi-structured interviews with ten key organisations were undertaken, as was an analysis of Senior/Disabled Persons Railcard data from 17 railway stations in Buckinghamshire, each with varying levels of step-free accessibility. Results: The results show that the benefits of step-free access extend beyond benefits at the individual level typically associated with those limited to PRMs, and demonstrate the potential to positively affect the society at large economically, environmentally, and socially. The findings also show a positive correlation between the level of step-free accessibility at a railway station and the percentage of PRMs using it. Conclusions: This research argues that government and interested stakeholders should commit to expanding the number and coverage of step-free stations throughout the UK. They should ensure that the appraisal process for investment in step-free accessibility appropriately captures both user and non-user benefits. [ABSTRACT FROM AUTHOR]

Systematic literature searching identified 29 relevant health and social sciences articles for review on the topic of austerity policies and their impacts on the health and social care of disabled, elderly and immigrants in the United Kingdom (UK). Since 2010, government changes to previously state-funded areas meant levels of funding and eligibility changed significantly. Self-funding or self-managing healthcare, but more often social care, was transferred to individuals. While additional funding was given for some treatments, prevention approaches were cut. More people had to depend on non-professional care, mostly from family. Many family carers received no professional advice or information and mostly had to reduce their own employment hours and income to care for a dependent. The quality of services, professional or non-professional, became poorer than pre-2010. These changes increased marginalisation and stigma. Consequently, many 'vulnerable' became 'vilified' – disabled, elderly and immigrants often of the worst affected. Government definitions of 'disability', 'elderly' and 'immigrant' change. UK changes reduced the health and social care available to individuals recently. Individuals were made responsible for knowing about changes that affected them and had to manage their care without professional guidance and support. Some had to use personal funding to maintain their quality of life. Many people felt stigmatised because of the changes and were nervous about seeking help they were entitled to. Health and social care should be joined-up and involve assessment, funding, and services offered as a package. This should be ideally focused on preventing worsening health, early treatment and support for managing long-term conditions. Judging that people currently contributing to the economy through work as those who deserve government services is wrong. Assisting the well-being of those who cannot currently contribute can recognise past contributions and improve potential to contribute, and may reduce future needs for government services. [ABSTRACT FROM AUTHOR]

Objectives: The Better Care Fund is the first and only national policy in England that has legally mandated the use of pooled budgets to support local health and social care systems to provide better integrated care. Methods: We report qualitative findings from the first national multi-method evaluation of the Better Care Fund, focusing on its implementation, perceptions of progress and expected impacts among key stakeholders. Interviews were carried out with 40 staff responsible for Better Care Fund implementation in 16 local health and social care sites between 2017 and 2018. Results: Study participants reported their experiences of implementation, and we present these in relation to three themes: organizational issues, relational issues and wider contextual issues. Participants stressed the practical and political challenges of managing pooled budgets and the complexity of working across geographical boundaries. In a context of unprecedented austerity, shared vision and strong leadership were even more vital to achieve collaborative outcomes. Conclusion: Pooling budgets through the Better Care Fund can lever closer collaboration between sectors and services. Shared vision and leadership are essential to develop and foster this closer collaboration. Although some successes were reported, the study highlights that there are major cultural, operational and territorial barriers to overcome. [ABSTRACT FROM AUTHOR]

Background we project incidence and prevalence of stroke in the UK and associated costs to society to 2035. We include future costs of health care, social care, unpaid care and lost productivity, drawing on recent estimates that there are almost 1 million people living with stroke and the current cost of their care is £26 billion. Methods we developed a model to produce projections, building on earlier work to estimate the costs of stroke care by age, gender and other characteristics. Our cell-based simulation model uses the 2014-based Office for National Statistics population projections; future trends in incidence and prevalence rates of stroke derived from an expert consultation exercise; and data from the Office for Budget Responsibility on expected future changes in productivity and average earnings. Results between 2015 and 2035, the number of strokes in the UK per year is projected to increase by 60% and the number of stroke survivors is projected to more than double. Under current patterns of care, the societal cost is projected to almost treble in constant prices over the period. The greatest increase is projected to be in social care costs—both public and private—which we anticipate will rise by as much as 250% between 2015 and 2035. Conclusion the costs of stroke care in the UK are expected to rise rapidly over the next two decades unless measures to prevent strokes and to reduce the disabling effects of strokes can be successfully developed and implemented. [ABSTRACT FROM AUTHOR]

This literature review was conducted to describe the range of organisations and informal groups providing peer support to personal budget users in the United Kingdom between the launch of direct payments in 1997 and 2016. Forty-five research reports included relevant evidence. This has been aggregated to show how peer networks supported individual users, as well as to describe their wider role in policy development and implementation. Despite their diversity, the support they provided often had common characteristics. Peer networks fostered collaboration, enhanced communication, built confidence amongst people who were entitled to a personal budget, and applied specialist knowledge that was often derived from the lived experience of network members. None of these characteristics was exclusive to peer networks. However, they may have been more deeply culturally embedded here than in other settings, which perhaps accounts for the positive experiences of support reported in the research literature. It is now more than 20 years since direct payments first enabled UK residents to take the money used to pay for their social services as personal budgets. Early research showed that support provided through peer networks including disabled people's organisations had particular advantages. Despite this, the proportion of support commissioned from peer networks has subsequently reduced. This review of the research literature details the helpful support provided by peer networks at each stage of obtaining and managing a personal budget. The approaches taken by peer networks were often innovative and original, and this article summarises their characteristics. [ABSTRACT FROM AUTHOR]

Aim: The Counterweight‐Plus weight management programme achieved 46% remission of Type 2 diabetes at 1 year in the DiRECT trial. We estimated the implementation costs of the Counterweight‐Plus programme and its 1‐year cost‐effectiveness in terms of diabetes remission, compared with usual care, from the UK National Health Service (NHS) perspective. Methods: Within‐trial total costs included programme set‐up and running costs (practitioner appointment visits, low‐energy formula diet sachets and training), oral anti‐diabetes and anti‐hypertensive medications, and healthcare contacts. Total costs were calculated for aggregated resource use for each participant and 95% confidence intervals (CI) were based on 1000 non‐parametric bootstrap iterations. Results: One‐year programme costs under trial conditions were estimated at £1137 per participant (95% CI £1071, £1205). The intervention led to a significant cost‐saving of £120 (95% CI £78, £163) for the oral anti‐diabetes drugs and £14 (95% CI £7.9, £22) for anti‐hypertensive medications compared with the control. Deducting the cost‐savings of all healthcare contacts from the intervention cost resulted an incremental cost of £982 (95% CI £732, £1258). Cost per 1 year of diabetes remission was £2359 (95% CI £1668, £3250). Conclusions: Remission of Type 2 diabetes within 1‐year can be achieved at a cost below the annual cost of diabetes (including complications). Providing a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with Type 2 diabetes to attempt remission. (Clinical Trial Registry No.: ISRCTN03267836) What's new?: Diabetes and its complications account for about 10% of healthcare budgets worldwide.The Counterweight‐Plus weight management programme in DiRECT achieved 46% remissions of Type 2 diabetes and improved cardiovascular risk factors at 1 year.One‐year incremental cost for the intervention group was estimated at £982 (95%CI £732, £1,258) per participant compared to the control arm.Providing the DiRECT/Counterweight‐Plus intervention in primary care incurs a cost (£2359 per 1‐year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including its complications), and has the potential for long‐term cost‐effectiveness.Providing that a reasonable proportion of remissions can be maintained over time, with multiple medical gains expected, and immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with diabetes to attempt remission as early as possible after diagnosis. [ABSTRACT FROM AUTHOR]

Aims: To develop a novel interactive budget impact model that assesses affordability of diabetes treatments in specific populations, and to test the model in a hypothetical scenario by estimating cost savings resulting from reduction in HbA1c from ≥69 mmol/mol (8.5%) to a target of 53 mmol/mol (7.0%) in adults with Type 1 diabetes in the UK. Methods: A dynamic, interactive model was created using the projected incidence and progression over a 5‐year horizon of diabetes‐related complications (micro‐ and macrovascular disease, severe hypoglycaemia and diabetic ketoacidosis) for different HbA1c levels, with flexible input of population size, complications and therapy costs, HbA1c distribution and other variables. The model took a National Health Service and societal perspective. Results: The model was developed, and in the proposed hypothetical situation, reductions in complications and expected costs evaluated. Achievement of target HbA1c in individuals with HbA1c ≥69 mmol/mol (8.5%) would reduce expected chronic complications from 6.8 to 1.2 events per 100 person‐years, and diabetic ketoacidosis from 14.5 to 1.0 events per 100 person‐years. Potential cumulative direct cost savings achievable in the modelled population were estimated at £687 m over 5 years (£5,585/person), with total (direct and indirect) savings of £1,034 m (£8,400/person). Conclusions: Implementation of strategies aimed at achieving target glucose levels in people with Type 1 diabetes in the UK has the potential to drive a significant reduction in complication costs. This estimate may provide insights into the potential for investment in achieving savings through improved diabetes care in the UK. What's new?: We describe a new interactive budget impact model that evaluates affordability of diabetes treatments and their independent impact on HbA1c and hypoglycaemia.We tested the model by simulating the effect of reducing HbA1c from ≥69 mmol/mol (8.5%) to 53 mmol/mol (7.0%) in an adult population with Type 1 diabetes in the UK.The model estimated that micro‐ and macro‐complications were reduced by >80%, and total cost savings of more than £8,000/person were achieved over a 5‐year period by strategies that obtain target glycaemic control.The model has potential to provide information about the affordability of diabetes treatments, and thus facilitate better resource planning, budget allocation and treatment uptake. [ABSTRACT FROM AUTHOR]

Child Rights Impact Assessment (CRIA) is used to assess systematically the impact on children of laws, policies or budgetary allocations as measured against the Articles of the UN Convention on the Rights of the Child (CRC) and domestic human rights/child wellbeing frameworks. Internationally, a small number of governments at central, regional and local level have introduced or attempted CRIA. However, where available, documentary analysis of the assessments and published evaluations of these existing models raise questions about the quality of the impact assessments being produced. This paper examines the use of CRIA with a particular focus on the UK and its devolved governments, looks at issues that can limit its effectiveness, and suggests what should be in place to support the potential of CRIA. These include: a clear mandate for CRIA with sustained political commitment, children's rights training and access to expert advice, tools to guide and shape the process, access to relevant data sets, and a clear expectation of involving children. Many of the practice findings draw on research conducted for UNICEF UK on CRIA practice in the UK. [ABSTRACT FROM AUTHOR]

While death features widely in various humanities and some social science disciplines, to date it has not been given the attention it deserves in social policy discourse or research. This paper sets out to begin to rectify that omission. Outlining a range of policy areas affected by death, it argues that budget and outcome-driven priorities in the UK have resulted in the evolution of disconnected and inconsistent policy responses to death. The paper begins by outlining death rates and characteristics of population ageing before focussing on social divisions in death and associated policies. It considers the death and UK social policy agenda before outlining the key characteristics involved in developing a coherent policy response and policy analysis in this field. It argues for a more comprehensive, consistent and joined up policy response to death, and corresponding academic study of death, which acknowledges and supports individuals preparing to die, when they die and those left behind. [ABSTRACT FROM AUTHOR]

This article examines how income poverty is affected by changes to the scale of tax-benefit policies and which are the most cost-effective policies in reducing poverty or limiting its increase in seven diverse EU countries. We do that by measuring the implications of increasing/reducing the scale of each policy instrument, using microsimulation methods while holding constant the policy design and national context. We consider commonly applied policy instruments with a direct effect on household income: child benefits, social assistance, income tax lower thresholds and a benchmark case of rescaling the whole tax-benefit system. We find that the assessment of the most cost-effective instrument may depend on the measure of poverty used and the direction and scale of the change. Nevertheless, our results indicate that the options that reduce poverty most cost-effectively in most countries are increasing child benefits and social assistance, while reducing the former is a particularly poverty-increasing way of making budgetary cuts. [ABSTRACT FROM AUTHOR]

Economic decisions - such as where investment is increased and or withdrawn, which services will flourish and which will be run down, whose living standards will be protected or boosted and whose reduced - are not gender neutral. Neoliberal policies in particular have disproportionately affected women, particularly low-income and BAME women, through their lack of interest in social investment and the cuts they are making to the resources and public services that sustain life. They treat women's unpaid labour as an expandable and costless resource that can absorb all the extra work that results from these cuts. This article discusses some of these effects, drawing in particular on data from the Women's Budget Group and work by feminist political economists. It also makes the case for investment in the social infrastructure as an engine of sustainable economic growth, and argues against a focus solely on investment in physical infrastructure and the creation of paid employment. [ABSTRACT FROM AUTHOR]

Personalised budgets have historically been provided to groups of people with varying long‐term health and social care needs. Since 2010, there has been increasing interest in providing personal budgets (PBs) to individuals with a history of drug and alcohol use in the UK, reflecting the policy and practice shift towards whole person recovery from substance use. However, information on implementing, delivering, and receiving such initiatives with this group is limited. This systematic review was conducted to identify and collate the existing experiences of providing personalised budgets to drug and alcohol users. Between March and April 2017, we searched six electronic and 11 grey literature databases for English language studies published between 1990 and April 2017 which described the implementation and delivery of personalised budget initiatives with drug and alcohol users. Search results (n = 6,749) were screened against inclusion and exclusion criteria; six records met the inclusion criteria. Across the studies, staff reported specific moral, ethical, and practical issues which affected the implementation and delivery of personalised budgets to drug and alcohol users. Staff working with drug and alcohol users with PBs reported greater job satisfaction due to having greater flexibility and autonomy but they had increased workloads and additional responsibilities beyond their remit and training. Drug and alcohol users' experiences of receiving personalised budgets included varying levels of awareness, knowledge, and control of their budgets, and difficulties in understanding what the budgets could be used for. Nevertheless, personalised budgets had been used to purchase various services and items beyond traditional drug and alcohol treatment. Outcomes for drug and alcohol users included reduced drug use, improved relationships, improved mental and physical well‐being, and better daily structure. Although the review suggests that providing personalised budgets to drug and alcohol users presents unique implementation and delivery challenges, these were not insurmountable. [ABSTRACT FROM AUTHOR]

Without data, many people may think pharmaceutical companies' influence over mental health services is negligible. We audited the marketing activities of, and payments to, drug companies in relation to public mental health services in England. Forty-three of 53 Trusts responded to Freedom-of-Information-Act requests. Trusts' policies varied in covering seven activities: from 86% (gifts) to 37% (leaflets). In practice, industry-sponsored training events (51%) and direct talks (40%) were common (averaging 36 events or talks per Trust annually). Only 22% of Trusts produced legally required Conflicts-of-Interests registers; and 14% had none. All 22 Trusts that reported which company received the largest share of their drug expenditure named the same company. On average, Trusts spent 44% of their drugs budget on long-acting injectable antipsychotics (13% to 77%) and 32% on brand name drugs (5%–74%). Five Trusts ban the Pharma marketing activities investigated. Independent post-qualification medical education, and marketing-bans, are needed to avoid over-medicalized practice. [ABSTRACT FROM AUTHOR]

Abstract For many local authority children and family services in the UK faced with the task of responding to children and families facing difficulties and with declining budgets, there is an increasing imperative on how services can respond more effectively to the diverse needs of families on the edge of care. At the same time policy and paradigm shifts have affected the way in which social workers engage with families. This paper is rooted in research commissioned by one local authority that used an innovative visual 'river of experience' co- production approach to understand better the experiences of children and families on their journeys to the edge of care and to inform how statutory services might respond 'better', and possibly earlier, to prevent children being taken into care. The research highlights the gap between assumptions and practices of child and family services and the realities and needs of children and families. The paper discusses these disjunctions and draws out questions to challenge statutory services. In particular, the paper asks why, in spite of serial involvement of professionals, do children still end up in the care system. The paper contributes to current discourses about rethinking child protection, arguing for a different approach to responding to families facing difficulties involving human centred, holistic family support and a more reflexive and relational approach to professional practice. Highlights • The continuing gap between services and the needs of children and families • Children's voices frequently go unheard in statutory professional interventions. • Insufficient attention to emotional/psychological legacy of early neglect • Reiterates the need for re-imagining child protection as family-centred practice • Need for Children and Family services to be flexible and adaptive learning systems [ABSTRACT FROM AUTHOR]

What is the effect of providing personally tailored budgetary information on public attitudes to tax and spending? We address this question with a survey experiment based on the annual tax summaries introduced by the UK tax authorities in 2014. By subtly manipulating the categories of state spending – in particular, the controversial category of ‘welfare’ – to invoke a sense of unfairness, we show how budget information in general and the United Kingdom’s annual tax summaries in particular impact support for state spending. Though the stated aim of providing personalised tax receipts to income taxpayers is to enhance fiscal transparency, doing so may also damage support for state spending if the information provides a sense that existing redistribution is unfair. The article contributes to political science debates about public attitudes to tax and spending, the character and trade-offs of fiscal transparency, and the framing effects of welfare. [ABSTRACT FROM AUTHOR]

• The UK Soft Drinks Industry Levy (SDIL) had a public consultation preceding implementation in 2018. • Industry stakeholders' submissions generally opposed the levy and denied it would have an impact. • However, submissions showed awareness of complexity in business relationships due to the levy. • A complex systems analysis approach allowed deeper analysis into relationships between arguments. The United Kingdom (UK) Chancellor of the exchequer announced a tax on sugar sweetened beverages in his March 2016 budget. A public consultation on the Soft Drinks Industry Levy (SDIL) was conducted before the levy's implementation in 2018. We aimed to identify arguments that industry stakeholders made during the public consultation to influence the discursive environment using thematic framework analysis with a novel complex systems lens. Forty-two censored consultation responses from industry stakeholders (manufacturers, retailers, or representative trade associations) were obtained by Freedom of Information requests to Her Majesty's Revenue & Customs and Her Majesty's Treasury. Industry stakeholders were overall opposed to the SDIL. Key themes included unintended consequences of the levy, denying the impact of the levy, the responsibility of government to industry over health, and proposals of alternative policies. Industry stakeholders created a discursive environment that showcased the complexity of business relationships in response to the levy, in contrast to linear causal arguments and simplistic solutions (e.g., consumer education). Documented industry discursive strategies were engaged, including promoting voluntary agreements, use of industry commissioned research, and questioning the effectiveness of the policy. Industry stakeholders' submissions presented opposition to an evidence-based policy and use of documented industry discursive strategies emphasised the need for a pro-active and transparent consultation process and stakeholder management. A complex systems approach, alongside robust evidence, can identify changing relationships and adaptations in response to a policy, and pre-empt industry positioning in future health policymaking by identifying areas of push-back in advance to allow better stakeholder management. [ABSTRACT FROM AUTHOR]

• Summary: English policy and practice guidance recommends local authorities offer personal budgets to all adults eligible for social care support using transparent and equitable allocation systems which maximise choice and control for users. This includes family and other unpaid carers as carers in England are entitled to their own personal budget. The Care Act 2014 strengthens carers' rights and places duties on authorities to assess and meet carers eligible support needs. However, little is known about how authorities assess and allocate resources to carers. This article explores this information gap drawing on data from a survey of English local authorities in two regions completed by carers lead officers and complemented by follow-up telephone interviews with a sub-sample of these officers. • Findings: Survey and interview results demonstrate wide practice variations around how social workers assess, calculate and distribute resources to carers. There is little uniformity across authorities. Carer eligibility criteria are used but thresholds vary and are often unclear. Most grants/personal budgets are allocated as single annual payments but how the level of these grant/personal budgets are calculated varies with little standardisation. • Applications: The article develops the evidence base surrounding resource allocation to carers through carer grants/personal budgets. Findings are timely as the Care Act 2014 will strengthen carers'rights alongside the continuing personalisation of adult social care. Discussing local authority policy and practice around key objectives of equity, transparency and carer choice, implications for future social work practice and its development are considered in light of the Care Act 2014. [ABSTRACT FROM AUTHOR]

On 7 December 1916, in a dramatic coup, Lloyd George supplanted Asquith and became prime minister. This marked the death of a great party and has generated huge controversy. For long, Lloyd George was condemned as the culprit but latterly his reputation has risen sharply. Asquith and Lloyd George came from very different wings of the party, imperialist and Little Englander. Asquith seemed the supreme insider, Lloyd George a supreme Welsh outsider. However in peacetime government, they formed a tremendous partnership. Their close association continued to the formation of the first coalition in May 1915. Then serious division came over military conscription, with Lloyd George moving towards his old foes, the Unionists. As minister for munitions, then secretary for war, he became publicly very critical of the conduct of the war. A great conflict arose over his demand for a new war committee. This was directed against the generals: he did not wish to become prime minister. It looked as if a compromise was possible. On 3 December 1916 Asquith agreed to such a committee but, fatally, reversed his view the next day, Crucial was his misjudgment of the Unionist leaders, especially Balfour. On 6 December the king asked Lloyd George to form a government. Asquith seriously exaggerated his own strength while Lloyd George now had growing Unionist support, the backing of Labour and of a majority of Liberal MPs mobilised by Addison. So Asquith fell and a governmental revolution followed - a new small war cabinet, a cabinet secretariat under Hankey, a secretariat of private advisors in the 'Garden Suburb' and an inexorable move towards prime ministerial (or quasi-presidential) government. In May 1918, the 'Maurice debate' saw the Liberals divided into pro- and anti-government factions; they were crushed at the subsequent general election. The party was thereafter haunted by December 1916 and responsibility was bitterly contested. Yet it should be remembered that before 7 December 1916, the two Liberal leaders formed a dynamic and commanding partnership, which changed British politics profoundly and irreversibly. [ABSTRACT FROM AUTHOR]

Personal health budgets ( PHBs) in England have been viewed as a vehicle for developing a personalised patient-based strategy within the substance misuse care pathway. In 2009, the Department of Health announced a 3-year pilot programme of PHBs to explore opportunities offered by this new initiative across a number of long-term health conditions, and commissioned an independent evaluation to run alongside as well as a separate study involving two pilot sites that were implementing PHBs within the substance misuse service. The study included a quantitative and qualitative strand. The qualitative strand involved 20 semi-structured interviews among organisational representatives at two time points (10 at each time point) between 2011 and 2012 which are the focus for this current paper. Overall, organisational representatives believed that PHBs had a positive impact on budget-holders with a drug and/or alcohol misuse problem, their families and the health and social care system. However, a number of concerns were discussed, many of which seemed to stem from the initial change management process during the early implementation stage of the pilot programme. This study provides guidance on how to implement and offer PHBs within the substance misuse care pathway: individuals potentially would benefit from receiving their PHB post-detox rather than at a crisis point; PHBs have the potential to improve the link to after-care services, and direct payments can provide greater choice and control, but sufficient protocols are required. [ABSTRACT FROM AUTHOR]

The construction of new domestic properties contributes 2% of UK territorial greenhouse gas (GHG) emissions. The UK government aims to increase construction of new homes in England by almost a third, to 300,000 per year by the mid-2020s, whilst simultaneously reducing emissions in line with its net zero 2050 commitment. In this paper, for the first time, the upfront embodied carbon cost of constructing domestic properties in the UK by 2050 is quantified. A bottom-up analysis modelling seven domestic building typologies was used, with the material use for each based on current UK practice. Possible interventions to reduce the embodied carbon cost are then analysed. The results show that maintaining today's levels of construction will use the remaining 2050 carbon budget apportioned to house building (160 MtCO 2 e) by 2036, and cause a substantial increase in domestic floor area per capita. However, construction could reduce and cease entirely by 2035 without reducing today's living floor area per capita (37.5 m 2), resulting in a substantially reduced cumulative embodied carbon of 88 MtCO 2 e by 2050. Increasing living floor area per capita to the EU average of 40.5 m2, can be achieved within the carbon budget and with zero emissions by 2050. In contrast, increasing house building to government targets will result in double the cumulative emissions than the budget allows. A number of carbon reduction interventions were then investigated. It was found that of to 75% embodied carbon savings can be achieved by simultaneously changing the typology share, increasing material efficiency, increasing conversion from non-residential buildings and increasing the use of timber for structural purposes. [Display omitted] [ABSTRACT FROM AUTHOR]

BACKGROUND: Provision of Augmentative and Alternative Communication (AAC) interventions have been acknowledged to be highly variable in England and elsewhere. OBJECTIVE: The aim of the project described in this paper was to provide data to inform service planning and delivery of services delivering AAC including communication aids. METHODS: A survey was developed by an expert group and administered by telephone interview to service managers of primary and secondary services providing AAC interventions at a local level in England and data were included from two hundred and twenty respondents. RESULTS: Services included had mean caseload sizes of 0.09% of the catchment population for AAC provision, with a mean of 0.017% of the catchment population for high tech communication aids. Significantly higher levels of caseload and spend were reported for services working with children and young people as compared to those working with adults. Mean levels of unmet need for AAC equating to approximately one in every eight individuals on services' caseloads were reported. CONCLUSIONS: Althoug [ABSTRACT FROM AUTHOR]

The cost of cancer drugs forms a rising proportion of health care budgets worldwide. A number of studies have examined international comparisons of initial cost, but there is little work on postlicensing price increases. To examine this, we compared cancer drug prices at initial sale andsubsequent price inflation in the United States and UnitedKingdom and also reviewed relevant price control mechanisms. Methods The 10 top-selling cancer drugs were selected, and their prices at initial launch and in 2015 were compared. Standard nondiscounted prices were obtained from the relevant annual copies of the RED BOOK and the British National Formulary. Results At initial marketing, prices were on average 42% higher in the United States than in the United Kingdom. After licensing in the United States, all 10 drugs had price rises averaging an overall annual 8.8% (range, 1.4% to 24.1%) increase. In comparison, in the United Kingdom, six drugs had unchanged prices, two had decreased prices, and two had modest price increases. The overall annual increase in the United Kingdom was 0.24%. Conclusion Cancer drug prices are rising substantially, both at their initial marketing price and, in the United States, at postlicensing prices. In the United Kingdom, the Pharmaceutical Price Regulation Scheme, an agreement between the government and the pharmaceutical industry, controls health care costs while allowing a return on investment and funds for research. The increasing costs of cancer drugs are approaching the limits of sustainability, and a similar government-industry agreement may allow stability for both health care provision and the pharmaceutical industry in the United States. [ABSTRACT FROM AUTHOR]

A country's budget is one of the most important public policy instruments, as it establishes the government's policy priorities and has the potential to determine winners and losers. The budget, however, is a mixture of different components and these get varying degrees of attention in the media. Drawing on sociology of news research, this paper seeks to explain this heterogeneous coverage of a budget's policy decisions. To do so, it uses a unique data set of over 5,000 articles of press coverage of six UK budgets (2008-2012). These articles are coded for the presence/absence of each of the budget's policy decision, via automated content analysis. On the basis of a multivariate negative binomial model, we find that the salience of a policy decision in the coverage is determined by its cost, whether it is negative (i.e., tax hikes and spending cuts) or positive, the income group that is the most affected by it, and the level of attention given to it by the government. [ABSTRACT FROM AUTHOR]

The article discusses budget review from from the Chartered Institute of Taxation (CIOT), Institute for Fiscal Studies (IFS) and Institute for Government (IfG). It is noted that budgets are a mixture of politics and highly technical measures. Topics include planning of corporate taxes, development of tax policy, and appreciation of tradeoffs.

This study explores the funding variations by English local authorities (LAs) in January 2014 for pupils with special educational needs and disability (SEND). Two quintile groups (n = 30) are used for comparing LAs with low and high levels of statements and case studies are presented to further explore the allocations. The research findings provide a baseline for LA critical self-reviews and benchmarking of any revised funding formulae. Authorities that make limited use of statements are found to have significantly lower budgets for SEND pupils with and without statements, are more inclusive and make use of statements to primarily access special settings. Evidence is presented to affirm that the government’s current allocation methods, in part based on past levels of funding, can seriously challenge and undermine those LAs with a policy of inclusion and controlled use of statements, as these latter LAs may also wish to make vigilant use of education, health and care plans from September 2014. [ABSTRACT FROM AUTHOR]

This article argues that the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are fatally flawed notwithstanding the apparent rigour of the process which produced them. These Regulations were the product of considerable deliberation following a sensitively executed public inquiry yet, it is argued, they rely too heavily on the rhetoric of criminal law while failing to take into account the competing norms for compliance and the impact of NHS budget constraints. Further, they push the CQC towards a heavy-handed deterrence approach to enforcement, which will increase hostility between regulatees and the inspectorate, and ultimately reduce the scope for developing the transparency about failures which is sorely needed in the NHS. This article challenges the contemporary wisdom that it is primarily knee-jerk regulatory responses that suffer from fatal flaws of this nature. [ABSTRACT FROM AUTHOR]

Personal budgets aim to increase choice and independence for people with social care needs but they remain underused by people with mental health problems compared to other disability groups. The use of personal budgets may impact on families in a variety of ways, both positive and negative. This paper draws on interviews, undertaken in 2012-2013 with 18 family carers and 12 mental health service users, that explored experiences of family involvement in accessing and managing personal budgets for a person with mental health-related social care needs. The sample was drawn from three sites across England, with additional carers being recruited via voluntary sector networks. Our findings show that for many people with severe mental health needs who lack motivation and confidence to negotiate access to personal budgets, carers may provide the necessary support to enable them to benefit from this form of social care support. We illustrate the role carers may play in initiating, pursuing and maximising the level of support available through personal budgets. However, some carers interviewed considered that personal budget funding was reduced because of practitioners' assumptions about carers' willingness and ability to provide support. We also report perceived tensions between family carers and practitioners around appropriate involvement in decision-making. The study findings have implications for local authorities, practitioners and family carers in supporting the involvement of family carers in support for people with severe mental health problems. [ABSTRACT FROM AUTHOR]

This paper reflects upon the gross discrepancies between the reassurances given in 2010 by the 2010-2015 UK Coalition Government that their budget and welfare cuts would fall ‘fairly’ across the income spectrum, and the reality of what had happened by the end of that government. It asks how the ‘distributional impact assessment’ provided with the 2010 Comprehensive Spending Review could have been so wrong. In seeking to answer this question, types of systematic bias are considered along with a discussion of ‘marginality’ in assessments of impact. Drawing upon the role of ‘power’ in impact assessment, it traces the ways in which methodological assumptions can eclipse the real life effects of policies behind ‘the average’ as well as by the unfair selection of the ‘unit-of-analysis’. [ABSTRACT FROM PUBLISHER]

This commentary focuses upon two developments – cuts to wage supplements and an increase in the National Minimum Wage – announced in the first full Conservative government budget in Britain for 18 years. The commentary analyses these through the concept of predistribution and critiques of it. The commentary argues that the two developments can be understood as a weak version of predistribution that will reproduce and deepen class and gender inequalities because of their bases in retrenching collective provision for households living in wage poverty, while increasing the emphasis upon market mechanisms (wages) as the predominate means of supporting such households. [ABSTRACT FROM AUTHOR]

This study estimates the annual total nitrogen balance of the UK from 1990 to 2020. The following inputs of nitrogen are considered: inorganic fertilizer, atmospheric deposition; food and feed imports; and biological nitrogen fixation. The outputs considered compose: atmospheric emissions; direct losses of sewage and industrial effluent to the sea; fluvial losses at source; food and feed exports; and terrestrial denitrification. It is shown that: (1) Inputs of inorganic fertilizer declined significantly over the study period with both atmospheric deposition and food and feed imports significantly increasing. (2) Outputs of total N also significantly declined with all output pathways decreasing except for atmospheric emissions and terrestrial denitrification to N. (3) The UK was a net source of total nitrogen in 1990 of approximately −1941 ± 224 kilotonnes N/year (−8 tonnes N/km/year; inter-quartile range of ±0.9 tonnes/km/year). However, by 2012, this net nitrogen source had decreased to about −1446 ± 195 kilotonnes N/year (−5.9 tonnes N/km/year). The future total N balance of the UK is being driven by declines in outputs rather than changes in inputs. The largest declines are in the atmospheric emissions of reactive nitrogen (N) and the fluvial flux of N such that by 2020 to the total N budget is predicted to be −1042 (±246) kilotonnes N/year (−4.2 tonnes N/km/year) and by 2031 the UK would be a net sink of total N. [ABSTRACT FROM AUTHOR]