Contemporary Issues in Health and Social Care Policy and Practice: A Comparative Introduction

Contemporary Issues in Health and Social Care Policy and Practice

Developing a model of citizenship for application within health and social care contexts: a community-based participatory approach

Health and Social Care Delivery Research (HSDR) Programme is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding evaluative research projects that have the potential to improve the quality, accessibility and organisation of health and social care services by providing useful outputs for decision-makers, staff, service users, academic, and public audiences. More information about the programme can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation, and evaluation. NIHR logic models presentin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.

The Evidence Synthesis Programme (ESP) is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by generating high-quality evidence syntheses (ES) to support evidence-informed health and care policy and practice. More information about the programme can be found on the NIHR website. A logic model is a graphical way to show how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can then be used to support programme planning, implementation and evaluation. NIHR logic models represent in a linear flow diagram the key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps. This logic model sets out the essential elements of, and pathway to, impact for the NIHR ESP. Evidence syntheses are research projects that use formal techniques to bring together, evaluate and combine data from multiple studies to summarise and make sense of the existing body of research evidence on a particular topic.

This is a conceptual paper proposing a new model of Strengths-Based Interprofessional Practice and Education (SB-IPE), incorporating appreciative inquiry and narrative, and its application to improve health and social care practice and policy for older adults. Within people, families, communities, and teams are people who understand their assets and culture, hold a collective wisdom derived from their individual biographies and shared history, and are deeply invested in their success. This wisdom and experience can be mined for strengths and best practices to improve health and social care for older adults and their families. The conceptual framework of the model and relationship between concepts are explained, reviewing and synthesizing relevant literature on the strengths perspective, interprofessional practice and education, evolution of the patient voice, appreciative inquiry, and narrative to leverage the voices and experiences of older adults, their families, and interprofessional teams. Providing person-, family-, and community-centered health and social care through SB-IPE involves eliciting, listening to, and processing stories and narratives, then coalescing and co-creating person/family/team narratives throughout the trajectory of care. Appreciate inquiry and narrative can be harnessed to imagine an improved experience of care for older adults and their families. Incorporating the potential disruption of the voices and perspectives of older adults and their families offers value for health and social care delivery and policy innovation. Application of the SB-IPE model holds promise for harnessing these voices and collective experiences leading from disruption to transformation of health and social care practice, health professions education, policy, and research.

This article examines current understandings regarding the causes of child maltreatment and its prediction and prevention. The answers to why some people hurt children, when others in similar circumstances do not, remain obstinately elusive. We look to philosophy to help understand the complexity of causal pathways of maltreatment. We draw on the seminal work of Mackie () on probabilistic causation and his notion of the ‘INUS condition’ (INUS is the acronym for insufficient but non‐redundant part of a condition that is itself unnecessary but sufficient for the result). This theory holds particular relevance for exploring complex social phenomena. Taking child abuse as an issue, we show how the concept of the INUS condition offers a new way of thinking about causal factors when they are neither necessary nor sufficient. It can be applied to clarify the complex nexus of potential risk factors that may – or may not – ‘cause’ adult perpetration of abuse. It also provides a framework for integrating the research on resilience factors with that on risk. Finally, we discuss the lessons for research, policy and practice that arise from this way of conceptualising the underlying causality of child maltreatment. Copyright © 2013 John Wiley & Sons, Ltd.‘The concept of the INUS condition offers a new way of thinking about causal factors’Key Practitioner Messages:There have been major efforts to create models of risk and prediction in child protection but it remains an imprecise science.Risk factors appear to be neither necessary nor sufficient conditions for maltreatment to occur.In this article, we adopt a philosophical position to help make sense of the complex causation of maltreatment.We show the implications of these new perspectives for health and social care policy and practice.

The Wales COVID-19 Evidence Centre (WCEC) was established from 2021-23 to ensure that the latest coronavirus (COVID-19) relevant research evidence was readily available to inform health and social care policy and practice decision-makers. Although decisions need to be evidence-based, ensuring that accessible and relevant research evidence is available to decision-makers is challenging, especially in a rapidly evolving pandemic environment when timeframes for decision-making are days or weeks rather than months or years. We set up knowledge mobilisation processes to bridge the gap between evidence review and informing decisions, making sure that the right information reaches the right people at the right time. To describe the knowledge mobilisation processes used by the WCEC, evaluate the impact of the WCEC rapid evidence reviews, and share lessons learned. Our knowledge mobilisation methods were flexible and tailored to meet stakeholders' needs. They included stakeholder co-production in our rapid evidence review processes, stakeholder-informed and participatory knowledge mobilisation, wider dissemination of outputs and associated activities including public engagement, capacity building and sharing of methodologies. Feedback on processes and evidence of impact was collected via stakeholder engagement and a stakeholder survey. Findings indicate that knowledge mobilisation processes successfully enabled use of the WCEC's rapid evidence reviews to inform policy and practice decision-makers during the COVID-19 pandemic in Wales. Realising actual public and patient benefit from this 'pathway to impact' work will take further time and resources. The WCEC knowledge mobilisation processes successfully supported co-production and use of rapid evidence review findings by scientific advisors and policy and practice decision-makers during the COVID-19 pandemic. Identified barriers and facilitators are of potential relevance to wider evidence initiatives, for setting up similar Centres during crisis situations, and supporting future evidence-based policy and practice decision-making.

Building an evidence base to underpin policy and practice in health and social care is one of the cornerstones of New Labour's modernization programme. However, the history of evaluation research in Britain and America suggests that this enterprise may be thwarted as much by politics as by methodological debates. The 'paradigm wars' that characterize the social sciences also feature in the field of evaluation research, and changes in the way 'health' is conceptualized in the 'new public health' have intensified debates about approaches to evaluation and what counts as evidence. Health Action Zones have been vaunted as both the 'flagships' of the government's health policy and as 'learning initiatives'. This paper uses the example of Health Action Zones to discuss the use of a theory-based approach to evaluation for the purpose of generating the policy learning needed to tackle health inequalities, drawing on experience in Plymouth. The limitations of the 'traditional' approach to evaluation are examined, along with recent guidance from the Medical Research Council about evaluating complex community initiatives. It is argued that the case for theory-based evaluation extends beyond criticism of the traditional approach to develop evaluation theory and practice from the perspective of critical realism. This approach to evaluation seeks explanation and understanding about how and why projects 'work' or not in specific contexts, rather than pragmatic solutions to de-contextualized problems. The paper concludes by reflecting on the politics of evaluation in the field of health and social care, calling into question the government's commitment to evidence-based policy and practice.

Irish health and social care policy has undergone a significant evolution in recent years to address inequalities, improve standards and update models of care to incorporate a rights‐based approach. The following account describes the Irish health and social care system, as delivered in the Republic of Ireland, and details how it operates for those with intellectual and developmental disabilities. The paper is informed by government policy, legislation, reviews, national plans, parliamentary reports, and population data. Clear progress has been made in shifting from a service‐led to a rights‐based, service‐user led model of care; however, resourcing this fundamental transition in approach to service provision poses challenges for the Irish State.

Section 1: Introduction 1. Something Old, Something New, Something Borrowed, Something Blue: Public Health in the Twenty-First Century Section 2: Unfair Cases: Social Inequalities in Health 2. Introduction 3. Social Capital and the Third Way in Public Health 4. Poverty, Policy and Pathogenesis: Economic Justice and Public Health 5. HIV Infection in Women: Social Inequalities as Determinants of Risk Section 3: Making Traces: Evidence for Practice and Evaluation 6. Introduction 7. Strong Theory, Flexible Methods: Evaluating Complex Community-Based Initiatives 8. Tackling Health Inequalities through Partnership Working: Learning from a Realistic Evaluation 9. Using Theory-Based Evaluation to Build Evidence-Based Health and Social Care Policy and Practice 10. Evaluating Evidence and Making Judgements of Study Quality: Loss of Evidence and Risks to Policy and Practice Decisions Section 4: Colonising Places: Public Health and Globalisation 11. Introduction 12. The Politics of Female Genital Surgery in Displaced Communities 13. International Governance and World Trade Organization (WTO) Reform 14. Medicine Keepers: Issues in Indigenous Health 15. Equity, Democracy and Globalisation Section 5: Edgy Spaces: Policy, Technology and the Public Health 16. Introduction 17. Moving Bodies: Injury, Disease and the Social Organisation of Space 18. Antibiotic Resistance: An Exemplary Case of Medical Nemesis 19. Introductions to Special Issue on Genetics 20. Passionate Epistemology, Critical Advocacy, and Public Health: Doing our Profession Proud

Holloway, M. Negotiating death in contemporary health and social care . Bristol : The Policy Press , 2007 viii + 216 pp. £60.00 (hbk) £19.99 ISBN 978-1-86134-722-0 ( pbk ) Holloway sets out in this book to provide a relevant knowledge base and a practice framework that is fit for purpose as a professional tool, and in so doing closely allies theoretical insights into death’s meanings in modern society with implications for contemporary professional health and social care practice. The author discusses attitudes and beliefs, issues of bereavement and grief, questions of euthanasia and assisted dying, assumptions and reality in respect of death in old age and end of life care, practices in regard to funerals and memorials, discussion of patterns and boundaries between public and private meanings of death, as well as current health and social care practice in respect of death and dying. Throughout the book the author makes brief and strategic use of case study material to illustrate discussion and in her final chapter usefully incorporates more detailed case studies to emphasise the ways in which theory can infuse and integrate with practice. Holloway articulates the often unstated but confounding influences in modern society that challenge our responses and actions, whether as general citizens or as professionals dealing with death and dying and highlights issues of personal control and choice, for example regarding timing and place of death, and human rights, for example balancing the rights of individuals and society in the context of euthanasia. Holloway argues that death is ‘complex’ in the social context of late modernity and valuably gives attention to sociological, philosophical and theological insights in addition to the more commonly aired ideas embedded in psychological and psychiatric perspectives. The aim of this broader examination is to provide a more integrated approach to the social as well as individual perspectives on death and, therefore, scope for better theoretical underpinning of practice and research. It is suggested that health and social care practice is not sufficiently co-ordinated in regard to an individual’s holistic needs at the end of life and also emphasises the importance of health and social care workers having time to provide necessary emotional support. Holloway consistently points out the relevance of paying close attention to religious and cultural dimensions, for example the need for practitioners to appreciate differences in how grief is expressed across cultures, but she does not lose sight of the fact that cultures are dynamic and so practitioners have to be sensitive to changing beliefs as well as tradition and also need to recognise that there are common features of grief that transcend cultures. The book is welcome and timely, given the demographic changes associated with an ageing population and the social, ethical and philosophical questions that arise. Holloway makes good use of a comprehensive range of references and helpfully includes ‘key questions for practitioners’ at the end of each chapter, to help the reader reflect on themes and their use in practice settings. The author also makes strategic use of vignettes, including material from the author’s practice, that exemplify key themes. I found the chapter on understanding bereavement and grief particularly helpful in regard to social care practice, as it includes a strong emphasis on the application of theory to practice in respect of attachment and loss, stage theories, continuing bonds and meaning-making. The same chapter includes a section on ‘special deaths’, such as murder, child death and drug overdose, to which could now be added, perhaps, the category of celebrity death, given the recent public attention to the deaths of Princess Diana and TV personality Jade Goody. Holloway argues that the general public are not sufficiently aware of advance care planning and advance directives and that as a result adults, whether young or old, tend to play a passive role in the way in which their end of life care is provided and managed. This may be particularly relevant in care homes, a setting where increasing numbers of older people receive end of life care and die but where, according to the author, staff typically lack confidence in talking about death and dying. Holloway usefully refers to pilot research that indicates the benefits of open discussion between care workers and service users, for example in regard to decisions on where to die, a finding that resonates with my own current research. Holloway is right to stress the central and enabling role of communication within good professional end of life care practice. The combination of thorough research, wide ranging theoretical perspectives and detailed examples from practice throughout the life course result in a fascinating and rewarding book that should appeal not only to those involved in palliative care but to health and social care professionals and academics across relevant disciplines.

At a Crossroads: Ada and Public Policy

The concept of healthy or successful ageing dates back to the 1960s, where its goal is more realistic in today's ageing society as a result of effective interventions to control and reduce disability and health risks. The aim of this paper is to outline the importance of defining ageing, the semantics and indicators used, and to identify common challenges for health professionals' understanding and application of a healthy ageing approach in their everyday clinical practice. This discursive paper demonstrates how realistic ageing indicators are for highlighting the variation and impact of challenges associated with ageing. It examines the proportion of older adults requiring aged-care services and allocation of resources, focusing on health maintenance and secondary ageing prevention. Indicators of ageing commonly used in clinical healthcare settings are reviewed, and their appropriateness for determining functional and intrinsic capacity of older adults. Other indicators are introduced, i.e., the Healthy Life Expectancy (HLE), Disability Free Life Expectancy (DFLE), the Human Development Index (HDI), and the Active Ageing Index (AAI), for enhancing and promoting a healthy ageing model of healthcare. Healthy ageing models of health and social care are also considered. Outlining evidence on healthy ageing may facilitate health professionals to address realistic challenges regarding age-related health and social care provision, using a personalised approach for every older adult as opposed to cutting off chronological age parameters. Increasing health professionals' focus on healthy ageing will maintain good health in at least 80% of the ageing population for longer. No patient or public contribution.

This article critically examines the impact of health and social care provision on separated categories of race, disability and neurodivergence. It deconstructs the racist impacts of the neoliberal individual budgets agenda as experienced by a young Black African person with intellectual disabilities and autism, living as a second-generation migrant in the UK. This article highlights intersectional methodological and practice implications for health and social care provision within England and Wales. The erasure of intersectional race, intellectual disability and neurodivergent identities in UK health and social care policies and practice procedures results in the invisibility, misrecognition and consequential misdiagnosis of the intersectional complexities of the needs and entitlements of young black people. The convergence of racist, disablist and elitist neoliberal agendas is identified as leading to increased risks of incarceration for young black people with intellectual disabilities and autism. The specificity of the individual needs of young black people with intellectual disabilities and autism demand anti-racist approaches that confront the assumption that Black African families in the UK ‘look after their own’ and require minimal social care involvement.

Objectives. The findings presented in this article were unanticipated and came to light during a study which investigated African and African-Caribbean fathers' views about preventive primary care services. This article reports findings which indicate that African and African-Caribbean fathers strive to enable and protect children's mental well-being and create social, cultural and symbolic forms of capital. It also seeks to identify implications for health and social care policy and practice in England. Design. There is limited literature examining African and African-Caribbean fathers' health experiences in England. Consequently an exploratory research approach was required. This involved nine, in-depth, semi-structured qualitative group interviews undertaken with 46 African and African-Caribbean fathers. The data were analysed thematically using abductive reasoning, informed by Bourdieu's theoretical work. Results. Fathers were striving to enable and protect children's mental well-being through providing authoritative, loving, affectionate fatherhood involving reasoning, good communication and promoting self-esteem. These practices were seen to be necessary if children were to prosper in a harsh social world characterised by structural hazards including racism, negative stereotypes and limited opportunities. The fathers reported their efforts to develop what Bourdieu has termed symbolic, cultural and social capital as means of promoting the mental well-being of their children and the children of others. Conclusion. The implications for theory, future research, public health policy and practice, in relation to the needs of African and African-Caribbean fathers and families, are also discussed, with specific focus on how to realise the potential of African and African-Caribbean fathers' positive contributions to family and community health.