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Can public sector reform change service performance for the better? This is a hotly contested debate that carries significant theoretical and practical importance. In England, as in many countries, modernisation was at the heart of local government reform and represented an interpretation of New Public Management into a policy framework. This paper examines the role of the modernisation change agenda in England and what this has subsequently meant for ‘service improvement’. Drawing on both document analyses and qualitative interviews with local government employees, we find that while modernisation sought to establish continuous improvement, unintended consequences of modernisation have led to Staff Reductions, Skill Deficiencies, and Loss of a Competent Middle Core in local government, as well as performance outcomes creating an environment for Commissioning, Service Reduction, and Self‐Policing. Implications for the lasting roles and behaviours of public managers affected by this national change agenda are discussed, and conclusions for theory and practice are drawn.

This paper draws from the Literacies for Learning in Further Education research project, funded through the Teaching and Learning Research Programme. Drawing on the empirical study of literacy practices in eight Childcare courses in Scotland and England, we seek to demonstrate that, integral to the learning careers of students are literacy careers through which their learning is mediated. In the process, by drawing upon the lens of literacy, we also challenge some of the common sense understandings of learning in childcare. In particular we suggest that the literacy practices of lower level courses can be more diverse than those of higher level courses, producing confusing literacy careers for the students involved. We also point to the complexity of the literacy careers in childcare, given that students are required to mediate different aspects of their experience through literacy. In particular there are the mediations made possible by the use of information technology and those entailed in relating work placements to classroom practice. We argue that students on vocational courses have complex literacy careers and that a literacies approach to learning helps to reveal this complexity.

Joanne KnowlesCore Medical Publishing, Knutsford, UKIntroduction: Donepezil is indicated for the symptomatic treatment of mild to moderate Alzheimer’s disease. It is a specific and reversible inhibitor of acetylcholinesterase (AChE); by increasing levels of available acetylcholine, donepezil may compensate for the loss of functioning cholinergic brain cells.Aims: This review evaluates the clinical impact of donepezil by assessing randomized controlled and open-label naturalistic trials, as well as observational studies. A broad perspective is gained of its effectiveness on various outcomes.Evidence review: There is strong evidence that donepezil has efficacy against the three major domains of Alzheimer’s disease symptoms, namely functional ability, behavior, and cognition. The strongest evidence is for improvement or less deterioration in global outcomes and cognition in the short to medium term. There is limited evidence that improved global outcomes are maintained in the long term and clear evidence to support long-term maintenance of cognitive benefits. Also, donepezil appears to maintain function in the long term and there is some level 1 and 2 evidence of improved or limited deterioration in behavior or mood in the short to medium term. Despite donepezil’s effects on major symptoms of Alzheimer’s disease, its impact on patients’ quality of life has not been consistently demonstrated, perhaps reflecting the difficulty of assessing this aspect in this patient population. Donepezil may also lessen caregiver burden. Donepezil has some effect on markers of brain function, but more data are needed to confirm a neuroprotective effect. There is limited and conflicting evidence that long-term donepezil treatment delays time to institutionalization. There is some evidence that donepezil may be cost effective, especially when unpaid caregiver costs are considered. Donepezil is generally safe and well tolerated.Clinical val