Councils In England Research Articles

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Remote and technology-mediated working during the COVID-19 pandemic: A qualitative exploration of the experiences of nurses working in general practice (the GenCo Study).

To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Participants continued to deliver a significant proportion of patient care in-person. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Standards for Reporting Qualitative Research (O'Brien etal.,2014). This was a workforce study so there was no patient or public contribution. The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward.

The well-being of nurses working in general practice during the COVID-19 pandemic: A qualitative study (The GenCo Study).

Exploration of experiences of nurses working in general practice during the COVID-19 pandemic to evaluate the impact on nurses' professional well-being. An exploratory qualitative study comprised of case studies of three general practice sites in England and a nationwide interview study of nurses working in general practice and nurse leaders. The study was funded by The General Nursing Council for England and Wales Trust. University of York ethics approval (HSRGC/2021/458/I) and Health Research Authority approval was obtained (IRAS: 30353, Protocol number: R23982, Ref 21/HRA/5132, CPMS: 51834). Forty participants took part. Case site data consisted of interviews/focus groups and national data consisted of semi-structured interviews. Data collection took place between April and August 2022. Analysis was underpinned by West etal.'s The courage of compassion. Supporting nurses and midwives to deliver high-quality care, The King's fund, 2020 ABC framework of nurses' core work well-being needs. The majority of participants experienced challenges to their professional well-being contributed to by lack of recognition, feeling undervalued and lack of involvement in higher-level decision-making. Some participants displayed burnout and stress. Structural and cultural issues contributed to this and many experiences pre-dated, but were exacerbated by, the COVID-19 pandemic. By mapping findings to the ABC framework, we highlight the impact of the COVID-19 pandemic on the well-being of nurses working in general practice and contributing workplace factors. The issues identified have implications for retention and for the future of nursing in general practice. The study highlights how this professional group can be supported in the future. The study contributes to our understanding of the experiences of nurses working in general practice during the COVID-19 pandemic and beyond. Findings have implications for this skilled and experienced workforce, for retention of nurses in general practice, the sustainability of the profession more broadly and care quality and patient safety. Standards for Reporting Qualitative Research (O'Brien etal. in Journal of the Association of American Medical Colleges, 89(9), 1245-1251, 2014). As this was a workforce study there was no patient or public contribution.

A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT.

Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. A three-arm cluster randomised controlled trial. Councils in England. Office workers. SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. The study was carried out in one sector, limiting generalisability. The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. There is a need for longer-term follow-up, as well as follow-up within different organisations. Current Controlled Trials ISRCTN11618007.

Feasibility and acceptability of using a patient reported outcome measure (OxFAB) to help patients with heart failure to recognise and communicate worsening symptoms to specialist nurses

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Nursing Council for England and Wales Trust Background The incidence of Heart Failure (HF) is increasing. Breathlessness and fatigue are symptoms that signal clinical deterioration. However, patients often do not recognise worsening symptoms. This can lead to avoidable hospital admission. We developed with patients a validated tool to evaluate fatigue and breathlessness (OxFAB) in patients with HF but had not established its acceptability and feasibility in clinical practice. Purpose To evaluate the feasibility and acceptability of OxFAB as a tool to optimise patient-specialist nurse communication of symptoms of fatigue and breathlessness. Methods A multi-method feasibility study conducted in HF nurse specialist clinics at two sites in England, between January 2022 and September 2022. Participants completed the tool in the clinics at 2 time points 4 to 7 weeks apart. The tool asked for symptom assessment over the previous 2 weeks. Acceptability was determined through qualitative interviews and adherence to OxFAB at the 2 time points. Feasibility was determined through questionnaire completion rates and qualitative interviews. Results Thirty-five patients and three HF nurse specialists completed the study. Nurse-led HF clinics were conducted either by telephone consultation remotely or face to face within the hospital setting. Over half the patient sample were male (58%), and 66% of the patients had HF with reduced ejection fraction, 86% NYHA Class II-III, age (µ68.5 years-SD 12.55) years. Eighty-one percent completed OxFAB in µ7.49 minutes (time-point 1) and µ6.59-mins (time-point 2). Interview data suggested that OxFAB was easy to complete, relevant and optimised symptom communication. Conclusion This feasibility study demonstrated OxFAB was acceptable and feasible in clinical practice to optimise patients-health professional communication of HF symptoms.

E060 Testing a new prototype osteoporosis shared decision-making intervention in UK Fracture Liaison Services: patient and clinician perspectives of ‘iFraP’

Abstract Background/Aims Shared decision-making (SDM) is a joint process in which a person and healthcare professional work together to reach decisions about care. The Improving uptake of Fracture Prevention drug treatments (iFraP) study developed a prototype theoretically-informed intervention consisting of a computerised decision aid (DA) and Fracture Liaison Service (FLS) clinician training package to improve SDM about osteoporosis medicines. This abstract focuses on the early prototype iFraP in-practice testing phase that explored perceived acceptability of iFraP by those using it, barriers to, and facilitators of, implementation of the prototype iFraP in practice, and necessary changes required ahead of a full-scale randomised controlled trial (RCT). Methods In-practice testing was conducted at one FLS site. Participating FLS clinicians completed the prototype iFraP clinician training package, covering enhanced communication skills (e.g SDM, risk communication and health literacy techniques). Consenting patients with a recent fragility fracture referred for an FLS consultation were eligible to participate. Three cycles of iFraP in-practice testing were completed. Each cycle included observed iFraP consultations and post-consultation patient think-aloud interviews. After each complete cycle, the FLS clinician(s) was interviewed. Data were analysed using a framework approach. The Theoretical Framework of Acceptability and Theoretical Domains Framework facilitated understanding of iFraP acceptability and barriers to, and facilitators of, implementation. Results Four FLS clinicians (3 nurses, 1 allied health professional) completed the iFraP clinician training and delivered 10 iFraP consultations (8 face-to-face, 2 telephone) using the iFraP DA with participating patients (n = 3 cycle 1; n = 3 cycle 2; n = 4 cycle 3). In total, the four FLS clinicians completed 7 interviews, with all 10 patients completing a post-consultation interview. Findings demonstrate that patients and clinicians perceived the prototype iFraP DA as acceptable. Clinicians suggested that the iFraP DA supported them to elicit and address patient perceptions, increase patient involvement, and provide patients with sufficient and accessible information. Patients and clinicians expressed wanting to use iFraP in future FLS appointments, with some clinicians continuing to use the DA outside of iFraP in-practice testing. Identified barriers included: some clinicians questioned both the use of iFraP DA with patients not recommended first-line drug treatment; and, expressed concern that iFraP DA could extend the consultation length. Our findings demonstrated necessary updates to meet user needs and overcome identified barriers to iFraP intervention use, including presentation and structural changes to support integration of the iFraP DA into the consultation flow. Clinicians also provided feedback to improve the training package, including the need to demonstrate the DA in use, and increased allocated time to practice using the DA. Conclusion The iFraP intervention was perceived as acceptable, with the potential to support SDM about osteoporosis medicines. The iFraP RCT will now test our improved iFraP intervention across 3 FLS sites in England. Disclosure L. Bullock: None. N. Tyler: None. M. Thompson: None. S. Ryan: Grants/research support; the General Nursing Council for England and Wales Trust. J. Lefroy: None. S. Leyland: None. J. Fleming: None. E.M. Clark: None. S. Thomas: Other; owns Prescribing Decision Support Ltd that developed the iFraP decision aid. C. Gidlow: None. C.P. Iglesias-Urrutia: None. T.W. O'Neill: Grants/research support; supported by the NIHR Manchester Biomedical Research Centre. C.D. Mallen: Grants/research support; funded by the NIHR Applied Research Collaboration West Midlands, funded by the NIHR School for Primary Care Research. C. Jinks: Grants/research support; part funded by NIHR Applied Research Collaboration (ARC) West Midlands. Z. Paskins: Grants/research support; funded by the National Institute for Health Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].

The False King Olaf and His Necklace of Letters

The False King Olaf and His Necklace of Letters

Enhancing employability through hospital placements for Biomedical Science students

Collaboration between Universities and hospitals has provided the National Health Service (NHS) with many excellent Biomedical Scientists through the placement year scheme. Here, we document the number of students joining the placement scheme and the number and type of hospital departments offering student placements over a 10-year period.&#x0D; Prior to 2012, students were able to join fully-funded placements through the Higher Education Funding Council for England (HEFCE). Since then, there has been a fluctuation in numbers completing a placement year at the University of Essex, but the employability of these graduates remains consistently higher than our 3-year graduates. We demonstrate the positive impact of completing a placement year in an NHS hospital laboratory for students, and the contribution to university metrics in good degrees and graduate outcomes as well as the provision of much needed, qualified biomedical science staff to hospitals.

A STUDY OF SOCIAL SUCCESS FACTORS OF KM FOR CREATION OF NEW KNOWLEDGE IN HIGHER EDUCATION

Dearing report by Higher Education Funding Council for England, 2006, suggested that in the times of intensified global competition, high- level skills and knowledge would become pertinent and indispensable for the country’s economic success. The SECI model of knowledge conversion given by Nonaka and his colleagues, is extensively used across industries and nations to explore the knowledge creation dimension of knowledge management. Areas of KM such as creation of novel knowledge and knowledge as intellectual capital require a lot of work and consideration from both theoretical as well as applied perspectives. With this in mind, the present study seeks to explore the social enablers or success factors contributing to knowledge creation in the higher education institutions in India. The findings suggest that the social success factors in the study significantly impact the process of knowledge creation. Moreover, different social enablers contribute significantly to different modes of the process of conversion and creation of new knowledge. The pragmatic implication of the present study could guide institutions to assess the prevalence of knowledge creation practices and success factors to be emphasized more to increase knowledge conversion and creation with respect to their organization.

Perspectives of attenders and non-attenders to SARS-CoV-2 asymptomatic community testing in England: a qualitative interview study

ObjectivesIn December 2020, Derbyshire County Council in England introduced ‘walk-in’ asymptomatic community COVID-19 testing sites. Our study aimed to explore people’s views of the newly established COVID-19 community testing (CT)...

Council tenancies and hoarding behaviours: A study with a large social landlord in England.

Hoarding behaviours are highly stigmatised and often hidden. People with problematic hoarding behaviours have a higher rate of mental health and other healthcare and social services utilisation. Hoarding is a community health problem, one factor being housing insecurity. Hoarding behaviours represent significant burden to housing providers, impact the community and dealing with it involves multiple community agencies. This study with a city council in England with a large housing stock (over 14,000 properties) in summer 2021 sought to understand the nature, circumstances and extent that hoarding presents. We developed a reporting system and conducted 11 interviews with housing officers in which they described a case to explain their involvement. Our report details the nature of 38 people who hoard: 47% had a known disability or vulnerability, 34% presented a fire and environmental risk, 87% lived alone and 60% were resident in flats. Our qualitative themes are: Working with others, Balancing an enforcement approach, Feeling conflicted, Complex needs of people who hoard and Staff needs. The cases described by the housing officers are combined into six case studies and illustrate the complex, multi-agency circumstances around decision making and risk stratification. Our findings point to housing officers as frontline professionals dealing with a public health and social care issue which is often the manifestation of complex life histories and mental health conditions. We suggest a greater focus on risk stratification and a more holistic approach to hoarding cases to effectively deal with this most complex of community health and social care issues.

Literary Echoes of the Fourth Lateran Council in England and France, 1215–1405 ed. by Maureen B. M. Boulton

Literary Echoes of the Fourth Lateran Council in England and France, 1215–1405 ed. by Maureen B. M. Boulton

Anticipating the Unanticipated: Ethnography and Crisis Response in the Public Sector

This case‐study emphasizes the importance of ethnographic research in the public sector, specifically regarding emergency preparedness and crisis‐response. In the summer of 2020, Surrey County Council in England commissioned a mixed‐method Community Impact Assessment to better assist and serve their residents during the Covid‐19 pandemic. Stripe Partners conducted the place‐based ethnographic work, helping discover insights that led directly to strategy change. The ethnographic and quantitative research went hand‐in‐hand and led to rich and meaningful insights that were able to confidently convince decision makers to create change. Our ethnographic work validated many of the quantitative findings, while simultaneously providing the depth that allowed them to accurately and most usefully allocate resources for change. We researched how local communities had been affected by Covid, conducting on‐the‐ground interviews in seven different towns in the region. We listened to their stories, and translated them into actionable opportunities for change, many of which we have been able to see come to fruition.

Literary Echoes of the Fourth Lateran Council in England and France, 1215–1405. Edited by Maureen B. M. Boulton. Papers in Mediaeval Studies 31. Toronto: Pontifical Institute of Mediaeval Studies, 2019. x + 322 pp. $95.00 cloth.

Literary Echoes of the Fourth Lateran Council in England and France, 1215–1405. Edited by Maureen B. M. Boulton. Papers in Mediaeval Studies 31. Toronto: Pontifical Institute of Mediaeval Studies, 2019. x + 322 pp. $95.00 cloth. - Volume 90 Issue 3

WiST and WinS across a surgical career: RCS England Council member

RCS England Council member Scarlett McNally describes her experience of WinS over the last 30 years.

Sentencing Multiple- Versus Single-Offence Cases: Does More Crime Mean Less Punishment?

Abstract The ‘totality principle’ in law aims to show mercy to offenders in multiple-offence (MO) cases and retain ordinal proportionality in punishing those who commit different categories of offence. The effect of this principle in practice, however, is largely unknown. The present study involved an analysis of data released by the Sentencing Council for England and Wales to estimate the prevalence of MO cases and compare the penalties they received against comparable single-offence (SO) cases. MO cases represented approximately half of the cases in the sample which included violent, property, drugs and driving offences. Offence-specific regression analyses revealed that MO/SO case status was not a significant predictor of receiving a custodial sentence or of custody length. Thus, by applying the totality principle, sentencers may be letting MO offenders ‘off lightly’. Potential explanations for this unintentional effect on decision-making lies in how the totality principle is defined and interpreted, and recommendations are made for revising the guideline on application of the totality principle.

Austerity, Localism, and the Possibility of Politics: Explaining Variation in Three Local Social Security Schemes Between Elected Councils in England

The Conservative-Liberal Democrat coalition government abolished the Discretionary Social Fund and Council Tax Benefit in the Welfare Reform Act 2012 as part of their programme of austerity, with powers to design replacement schemes devolved to local authorities in England. Discretionary Housing Payments, which had long been the responsibility of local authorities, were given an expanded role – to soften the edges of welfare reform being pursued by central government. This article presents analysis of a new quantitative dataset constructed by the author detailing variations in these three payments across local authorities in England. This analysis explores the variation in provision that now exists across England and examines the extent to which the political makeup of elected councils, as well as economic and demographic differences, can explain the variations in provision that now exist. We find that there has been substantial retrenchment in the local social security schemes in the period since their localisation, indicating that the devolution of powers alongside budget cuts has proved a successful mechanism for implementing austerity. We also find that the political makeup of elected councils is associated with the degree of cutbacks in these schemes, with Labour-led councils less likely to retrench across all three payments when compared with councils led by the Conservative party, suggesting that politics remains possible even in a harsh financial climate such as that faced by local authorities in England.

Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT.

Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. This trial was set in 12 councils in England with adult social services responsibilities. Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group - control group difference: mean -£909, 95% confidence interval -£5336 to £3345) or in societal costs (intervention group - control group difference: mean -£3545; 95% confidence interval -£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval -0.204 to -0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants' health and social care or societal costs. Quality-adjusted life-years based on participants' EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. Current Controlled Trials ISRCTN86537017. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.

「北部イングランド女性高等教育協議会」における教育職女性の自己教育運動の展開:―ガヴァネス救済から大学拡張講義ヘ―

「北部イングランド女性高等教育協議会」における教育職女性の自己教育運動の展開:―ガヴァネス救済から大学拡張講義ヘ―

Maureen B. M. Boulton (ed.), Literary Echoes of the Fourth Lateran Council in England and France, 1215-1405

Le present ouvrage, coordonne par Maureen Boulton, professeur emerite de francais a l’universite Notre-Dame, s’inscrit dans une tendance recente de la recherche internationale qui vise a croiser les sources theologiques, doctrinales et ecclesiales avec les sources litteraires. L’enjeu est d’autant plus important que l’ouvrage se concentre ici sur le « moment 1215 », soit le Concile de Latran IV. Produit d’une rencontre en novembre 2015 a Rome, pour la commemoration du 800e anniversaire du gra...