County Borough Research Articles

Explaining Local Authority Choices on Public Hospital Provision in the 1930s: A Public Policy Hypothesis

This article summarises the findings of recent work on local authority public hospital services in England and Wales in the inter-war years and identifies the lack of a robust hypothesis to explain the variations found, particularly one that would explain the actions of county councils as well as county boroughs. Using public policy techniques on a group of local authorities in the far South West it proposes that variations can be explained by an understanding of the deep core beliefs of councillors, their previous experience of ‘commissioner’ and ‘provider’ roles, and the availability or otherwise of a dedicated policy entrepreneur to promote change.

Enhancing ventilation in homes of children with asthma: pragmatic randomised controlled trial

Few robust studies have tested whether enhancing housing also improves health. To evaluate the effectiveness of installing ventilation systems, and central heating where necessary, in the homes of children with moderate or severe asthma. Pragmatic randomised controlled trial (RCT) in homes within Wrexham County Borough, Wales, UK. A pragmatic RCT was carried out, of a tailored package of housing improvements providing adequate ventilation and temperature, following inspection by a housing officer. One hundred and ninety-two children with asthma aged 5 to 14 years, identified from general practice registers, were randomised to receive this package, either immediately or a year after recruitment. At baseline, and after 4 and 12 months, parents reported their child's asthma-specific and generic quality of life, and days off school. The package improved parent-reported asthma-specific quality of life significantly at both 4 and 12 months. At 12 months, this showed an adjusted mean difference between groups of 7.1 points (95% confidence interval [CI] = 2.8 to 11.4, P= 0.001): a moderate standardised effect size of 0.42. The generic quality-of-life scale showed reported physical problems were significantly reduced at 4 months, but not quite at 12 months, when the mean difference was 4.5 (95% CI = -0.2 to 9.1, P= 0.061). The improvement in psychosocial quality of life at 12 months was not significant, with a mean difference of 2.2 (95% CI = -1.9 to 6.4, P= 0.292). Parent-reported school attendance improved, but not significantly. This novel and pragmatic trial, with integrated economic evaluation, found that tailored improvement of the housing of children with moderate to severe asthma significantly increases parent-reported asthma-related quality of life and reduces physical problems. Collaborative housing initiatives have potential to improve health.

Enhancing ventilation in homes of children with asthma: cost-effectiveness study alongside randomised controlled trial

There has been little rigorous economic analysis of the relationship between asthma and improved housing. To evaluate the cost-effectiveness of installing ventilation systems, and central heating if necessary, in homes of children with 'moderate' or 'severe' asthma. An incremental cost-effectiveness analysis alongside a pragmatic randomised controlled trial of a tailored package of housing modifications designed to improve ventilation and household heating in homes within Wrexham County Borough, Wales, UK. A total of 177 children aged between 5 and 14 years, identified from general practice registers, were studied. Parents reported on the quality of life of their children over a 12-month period. General practices reported on health-service resources used by those children, and their asthma-related prescriptions, over the same period. The tailored package shifted 17% of children in the intervention group from 'severe' to 'moderate' asthma, compared with a 3% shift in the control group. The mean cost of these modifications was £1718 per child treated or £12300 per child shifted from 'severe' to 'moderate'. Healthcare costs over 12 months following randomisation did not differ significantly between intervention and control groups. Bootstrapping gave an incremental cost-effectiveness ratio (ICER) of £234 per point improvement on the 100-point PedsQL™ asthma-specific scale, with 95% confidence interval (CI) = £140 to £590. The ICER fell to £165 (95% CI = £84 to £424) for children with 'severe' asthma. This novel and pragmatic trial, with integrated economic evaluation, reported that tailored improvement of the housing of children with moderate to severe asthma is likely to be a cost-effective use of public resources. This is a rare example of evidence for collaboration between local government and the NHS.

Adequacy of thyroid hormone replacement in a general population

Suboptimal thyroid hormone replacement may carry harmful health consequences. Our objectives were to determine the prevalence and factors associated with inadequate replacement in patients receiving treatment with levothyroxine. Retrospective general practice audit. We identified levothyroxine users through electronic searches of primary care records in all 11 practices within a county borough. The adequacy of thyroid hormone replacement was determined from the current serum, serum thyrotropin (TSH) as: (i) adequate replacement (normal TSH; 0.4-4.0 mU/l); (ii) over replacement (low TSH; <0.4 mU/l); and (iii) under replacement (high TSH; >4.0 mU/l). Out of a registered patient population of 58 567, we identified 1037 patients who were first included in the hypothyroidism disease register between January 2004 and December 2009 (mean age 62.4 ± 15.9 years; female 85.9%, male 14.1%). Inadequate replacement was seen in 385 patients (37.2%), comprising 205 patients (19.8%) with over replacement and 180 patients (17.4%) with under replacement. Step-wise logistic regression showed that the factors associated with under replacement were male gender [odds ratio (OR) 2.85, confidence interval (CI) 1.86-4.38; P < 0.001 and younger age (OR 0.88, CI 0.80-0.98; P = 0.02 per 10 year increase in age) while longer duration of treatment was associated with over-treatment (OR 1.06, CI 1.01-1.10). A thyroid function test was performed in the preceding 12 months in 914 patients (88.1%) and appropriate dose adjustments had been made in 81.0% (312/385) of patients with abnormal results. Despite frequent monitoring and dose adjustment activities, inadequate thyroid hormone replacement remained a problem in over a third of levothyroxine users in this population.

An historical geography of liberty: Lancashire and the Inebriates Acts

This paper examines the Inebriates Acts of 1879 and 1898 which facilitated the formal provision of institutional care for inebriates. The Acts' permissive character produced an uneven geography of provision of institutions that meant that inebriate treatment varied markedly across the counties and county boroughs of England and Wales. The vast majority of those committed under the Acts were women. Using two exemplary case studies from Lancashire, a private retreat created under the 1879 Act and a council run reformatory created under the 1898 Act, the paper considers how debates about liberty and control shaped the regulation of problem drunkards. It shows that geography was as important as class, religion, and gender in determining who was subjected to regulation. The paper argues that the failure to reform inebriates helped the recoding of inebriety within a broader discourse of mental deficiency that encouraged the permanent segregation of problem populations.

Outsourcing in reverse: A case study from the public sector

At a time when many public organizations were looking to outsource their information technology services, Torfaen County Borough Council in Wales took a strategic decision to bring all information communications technology services in-house. The key challenge was to bring together and integrate a highly skilled, complex, and diverse mix of existing internal and external service providers.

Twenty-nine per cent Women Councillors after a Mere 100 Years

Just over 100 years ago, 5 pioneering women and 1 quite exceptional one became the first legitimately elected female members of English county and county borough councils. While obviously important, the Qualification of Women Act 1907 that enabled their election was far from the only one to have influenced women's electoral involvement in local government. Their first real opportunity had come in 1870, when the remarkably female-friendly electoral system introduced in Forster's Education Act enabled women to become elected members of school boards — one of the very first being the `quite exceptional' woman mentioned above, Elizabeth Garrett Anderson. The first part of this article examines the rules governing women's 19th-century voting and candidacy rights, and concludes that they were a decisive factor in determining both the extent and nature of women's participation in public life. The second part examines the comparable modern-day rules surrounding electoral systems and gender quotas and suggests that they are similarly influential in determining — or limiting — the representational diversity in our elected governmental bodies. With women comprising just 29 per cent of English councillors after more than a century, the time has surely come, the article concludes, to follow other countries in their utilization of electoral quotas.

Between Less Eligibility and the NHS: The Changing Place of Poor Law Hospitals in England and Wales, 1929-39

In 1929, the Local Government Act broke up the apparatus of the Poor Law Guardians and Unions, and transferred responsibility for the care of the poor to local councils. In theory, the period between the passing of the Act and the formation of the National Health Service witnessed a large-scale reclassification of the sick poor as patients rather than paupers. In reality, as this investigation of contemporary judgements of hospital quality and bed and staff numbers in English and Welsh county boroughs shows, the national picture was very varied at the local level. Local and sometimes regional traditions of care, finance and council priorities had a large influence on the ongoing development of a unified medical service which included the poor. In the best case scenario, hospitals were classified by patient type, and the principle of 'less eligibility' was discarded. Elsewhere, economic status continued to direct medical treatment, but in almost all cases, the chronic and elderly poor were more likely to remain in low-quality and unmodernized buildings than the acutely sick. The investigation highlights the disjuncture between the changed vision for the sick poor and its patchy enforcement on the ground.

An evaluation of the needs and service usage of family carers of people with dementia

This study investigated, by way of interview (n=45), the needs of those caring for a person with dementia and their satisfaction with current services in the Caerphilly County Borough of South Wales. Carers reported having the most difficulty coping with the demands on their time and the emotional strain associated with caring. Carers requested more information regarding available services, the diagnosis of dementia and the legal and financial aspects of caring. They also mentioned the need for a night‐sitter service, a 24‐hour helpline, more support groups and more visits from social workers and community psychiatric nurses (CPNs). On the whole, the carers were satisfied with the services provided, although their use of these services was not extensive. However, issues around lack of support, quality and availability of homes and hospitals and poor communications were identified as areas of concern. The findings were welcomed by strategic planners and the information is being used as a basis for developing and improving specific carer support services.

The experience of community sport development: a case study of Blaenau Gwent

In this paper, the experience of community sport development (CSD) is explored through case study evidence from Blaenau Gwent County Borough Council – an area of social disadvantage in the South Wales valleys. An empirically informed theoretical account is presented based on three key themes: (a) community development and social capital; (b) nurturing citizenship; and (c) resistance to paternalism. As a result, a re-conceptualisation of CSD is advanced in which there is an explicit recognition of the tripartite relationship between community, citizens and providers as part of an understanding of new governance. This in turn requires a shift away from dichotomous ‘bottom–up’ and ‘top–down’ approaches towards a non-hierarchical emphasis for CSD.

Perceptions of the neighbourhood environment and self rated health: a multilevel analysis of the Caerphilly Health and Social Needs Study

BackgroundIn this study we examined whether (1) the neighbourhood aspects of access to amenities, neighbourhood quality, neighbourhood disorder, and neighbourhood social cohesion are associated with people's self rated health, (2) these health effects reflect differences in socio-demographic composition and/or neighbourhood deprivation, and (3) the associations with the different aspects of the neighbourhood environment vary between men and women.MethodsData from the cross-sectional Caerphilly Health and Social Needs Survey were analysed using multilevel modelling, with individuals nested within enumeration districts. In this study we used the responses of people under 75 years of age (n = 10,892). The response rate of this subgroup was 62.3%. All individual responses were geo-referenced to the 325 census enumeration districts of Caerphilly county borough.ResultsThe neighbourhood attributes of poor access to amenities, poor neighbourhood quality, neighbourhood disorder, lack of social cohesion, and neighbourhood deprivation were associated with the reporting of poor health. These effects were attenuated when controlling for individual and collective socio-economic status. Lack of social cohesion significantly increased the odds of women reporting poor health, but did not increase the odds of men reporting poor health. In contrast, unemployment significantly affected men's health, but not women's health.ConclusionThis study shows that different aspects of the neighbourhood environment are associated with people's self rated health, which may partly reflect the health impacts of neighbourhood socio-economic status. The findings further suggest that the social environment is more important for women's health, but that individual socio-economic status is more important for men's health.

The difficulties surrounding local authority kitchen waste collection

The Cardiff School of Engineering has examined numerous aspects with regard to increasing the diversion of household waste through kerbside recycling and composting schemes. Research has shown that there is a need to target and collect the kitchen/food waste stream to meet the 2010 Welsh Assembly Government (WAG) target of 40% recycling and/or composting. The WAG 2003 analysis of household waste showed that green waste made up 28% of a Welsh municipal solid waste, of which 12% was garden waste and 16% was kitchen waste. Therefore, the 15% minimum source-separated composting target by the year 2010 cannot be met by targeting garden waste alone. A case study authority is used as an example to show Rhondda Cynon Taf County Borough Council’s current biodegradable municipal waste (BMW) diversion through traditional diversion routes. The BMW diversion deficit in meeting the Landfill Allowance Scheme Regulations is quantified and the potential fine for the case study authority is highlighted. This paper examines numerous aspects associated with the way other local authorities collect kitchen waste in England and Wales. The best practice of kitchen waste collection is identified in UK local authorities and the potential additional diversion attributed to this is then transferred to the case study authority. Subsequent predictions are made about the implementation of a full kitchen waste collection scheme. A distinct lack of data relating to kitchen waste collection in the UK has been identified.

Whose Claim is it? A Critical Assessment of the Re Oasis Merchandising Services Orthodox

The lynchpin of the reasoning in Re Oasis Merchandising Services [1998] Ch 170 - the ownership of claims brought by an insolvency officeholder being dependent on the distinction between the company's assets and the officeholder's statutory rights - is erroneous in principle and contrary to authorities. In light of Smith (Administrator of Cosslett (Contractors)) v Bridgend County Borough Council [2001] UKHL 58, claims under ss 127, 213, 214, 238, 239 and 245 of the Insolvency Act 1986 (and their resulting proceeds) belong to the company in administration or liquidation. There is no inherent logical divide between a pre-insolvency debenture's scope and the fruits of an officeholder's claims.

Discussion on the Green Tax Stimulation Measure of Nitrogen Fertilizer Non-Point Source Pollution Control – Taking the Dongting Lake Area in China as a Case

Abstract A study on designing the tax of nitrogen fertilizer can provide a new method for controlling nitrogen fertilizer non-point source pollution. The tax design of nitrogen fertilizer was discussed by utilizing the external theory and the demand elasticity theory. The results indicated that the coefficient of price elasticity of nitrogen fertilizer demand is -0.21, which instructed that the market demand is in lack of elasticity in the short period and the impact of nitrogen fertilizer manufacturers is subtle. The 11 counties (cities and boroughs) in the Dongting Lake area in China, where the farmland nitrogen application surpassed the average ecological fertilization dosage, is listed to the taxation scope of nitrogen fertilizer tax. The environment loss will reduce 0.07 hundred million RMB yuan and the revenue will increase 0.89 hundred million RMB yuan in the country after levying on nitrogen fertilizer. The loss, which was brought by the decreasing food supplies production, will be 0.58 hundred million RMB yuan and the net social benefit will be 0.38 hundred million RMB yuan following revenue collection. The variation scope of the increasing expenditure of farmers will range from 0.95 to 1.49%. The variation scope of the income of farmers will range from -8.41 to 6.44%. The 5 areas, Yunxi Borough, Junshan Borough, Hanshou County, Jinshi City, and Ziyang Borough, had an increase in food supplies production after the revenue collection. The environment loss will reduce 0.01 hundred million RMB yuan and the revenue will increase 0.16 hundred million RMB yuan in the country after levying on nitrogen fertilizer. The economic benefits, which was brought by the increasing cereals production, will be 0.67 hundred million RMB yuan and the net social benefit will be 0.84 hundred million RMB yuan after revenue collection. The variation scope of the increasing expenditure of farmers will range from 0.95 to 1.06%. The variation scope of the increasing income of farmers will range from 0.69 to 6.44%. Considering the entire social welfare, taxation of nitrogen fertilizer will have more advantages than disadvantages in the Dongting Lake area.

County Borough Elections in England and Wales, 1919-1938: A Comparative Analysis. Vol. III: Chester-East Ham

County Borough Elections in England and Wales, 1919-1938: A Comparative Analysis. Vol. III: Chester-East Ham

Central and Local Government and the Provision of Municipal Medicine, 1919-39

This article examines the relationship between central and local government - and specifically the County Boroughs - in interwar England and Wales with respect to the provision of municipal health services. It is argued that this relationship was complex, with different local authorities being compliant to a greater or lesser degree with the aspirations of the Ministry of Health. The latter, it is further suggested, started off its life as a relatively dynamic, well-run and farsighted part of central government, but for a range of reasons lost authority and influence as the interwar era progressed. This was not helped by the limited powers the Ministry held. The local authorities, meanwhile, differed widely in their aspirations for municipally-provided health care. Some were reluctant to do much, others had ambitions somewhat in advance of those of the Ministry of Health. What did unite local authorities was their collective desire to preserve the longstanding tradition of a high degree of local independence. As is also shown, specifically local factors and personnel - for example the political dynamics of the council or the standing of the Medical Officer of Health - could significantly shape a County Borough's approach to health care. The article thus contributes to the history of English and Welsh local government and, especially, to the relatively neglected period in the history of the health services which falls between the demise of the Poor Law and the coming of the National Health Service.

Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis

Despite the increasing belief that the places where people live influence their health, there is surprisingly little consistent evidence for their associations with mental health. We investigated the joint effect of community and individual-level socio-economic deprivation and social cohesion on individual mental health status. Multilevel analysis of population survey data on 10,653 adults aged 18-74 years nested within the 325 census enumeration districts in Caerphilly county borough, Wales, UK. The outcome measure was the Mental Health Inventory (MHI-5) subscale of the SF-36 instrument. A social cohesion subscale was derived from a factor analysis of responses to the Neighbourhood Cohesion scale and was modelled at individual and area level. Area income deprivation was measured by the percentage of low income households. Poor mental health was significantly associated with area-level income deprivation and low social cohesion after adjusting for individual risk factors. High social cohesion significantly modified the association between income deprivation and mental health: the difference between the predicted mean area mental health scores at the 10th and 90th centiles of the low income distribution was 3.7 in the low cohesion group and 0.9 in the high cohesion group (difference of the difference in means = 2.8, 95% CI: 0.2, 5.4). Income deprivation and social cohesion measured at community level are potentially important joint determinants of mental health. Further research on the impact of the social environment on mental health should investigate causal pathways in a longitudinal study.

Re-audit of clients from ethnic and local communities in Greater Manchester attending St. Mary’s Sexual Assault Referral Centre

A re-audit was conducted at St. Mary’s Sexual Assault Referral Centre to assess recording of clients’ ethnicity, area of residence and assault type following training that drew on results of an initial audit. This also reassesses the ethnic and local community representation of clients in the light of more recent census data for Greater Manchester. Performances of recording ethnicity, area of residence, and assault type relevant to all new clients in 2003 ( n = 805) were measured against standards. Figures relating to local and ethnic populations were also compared to 2001 census data as a guide. Recording clients’ ethnicity improved considerably, but recording area of residence slipped just below standard, and recording assault type dropped markedly. Overall ethnic minority representation was above general population figures, but differences existed within communities. Manchester city resident clients were over-represented compared to other county boroughs. Numbers of all clients seen at the centre had increased sharply since the original audit. Staff training following the original audit appeared to improve recording of ethnicity, whilst the heavy drop in assault type was largely attributed to an increase of referrals where the clients were not fully unconscious during the assault. The high number of Black and dual-heritage clients accounted for the ‘over-representation’ of ethnic minorities, masking under-representation of other ethnic communities, especially Asians. The ‘over-representation’ of Manchester city residents was seen to persist.

An ecometric analysis of neighbourhood cohesion

BackgroundIt is widely believed that the social environment has an important influence on health, but there is less certainty about how to measure specific factors within the social environment that could link the neighbourhood of residence to a health outcome. The objectives of the study were to examine the underlying constructs captured by an adapted version of Buckner's neighbourhood cohesion scale, and to assess the reliability of the scale at the small-area-level by combining ecometric methodology with ordinal modelling of a five-point scale.MethodsData were analysed from 11,078 participants in the Caerphilly Health and Social Needs Study, who were sampled from within 325 UK census enumeration districts in Caerphilly county borough, Wales, UK. The responses of interest came from 15 question items designed to capture different facets of neighbourhood cohesion. Factor analysis was used to identify constructs underlying the neighbourhood cohesion item responses. Using a multilevel ecometric model, the variability present in these ordinal responses was decomposed into contextual, compositional, item-level and residual components.ResultsTwo constructs labelled neighbourhood belonging and social cohesion were identified, and variability in both constructs was modelled at each level of the multilevel structure. The intra-neighbourhood correlations were 6.4% and 1.0% for the neighbourhood belonging and social cohesion subscales, respectively. Given the large sample size, contextual neighbourhood cohesion scores can be estimated reliably. The wide variation in the observed frequency of occurence of the scale item activities suggests that the two subscales have desirable ecometric properties. Further, the majority of between-neighbourhood variation is not explained by the socio-demographic characteristics of the individual respondents.ConclusionAssessment of the properties of the adapted neighbourhood cohesion scale using factor analysis and ecometric analysis extended to an ordinal scale has shown that the items allow fine discrimination between individuals. However, large sample sizes are needed in order to accurately estimate contextual neighbourhood cohesion. The scale is therefore appropriate for use in the measurement of neighbourhood cohesion at small-area-level in future studies of neighbourhoods and health.

An investigation into the kerbside recycling behaviour of two Welsh case study authorities

This paper investigates the number of observed households setting out their containers for kerbside recyclable collection in two Welsh kerbside recycling programmes; namely, Rhondda Cynon Taf County Borough Council and Caerphilly County Borough Council. Analysed data from the monitoring of approximately 114 000 households in the two separate kerbside programmes are presented, making this the largest study of kerbside recycling behaviour in the UK. The average household set-out rates of individual households per electoral division and per street in each programme were compared. Average household set-out rate for a particular electoral division and street was then related to certain socio-economic indicators. The study was performed using the 'ArcView' geographical information systems (GIS) package. The model identified a moderate link between household set-out rate (%) and socio-economic status at electoral division level. However, there was no correlation between socio-economic status and average household set-out rate in a street. Household set-out rates for both programmes fluctuated significantly in streets with similar socio-economic status. Another significant factor affecting set-out rate, herein named the 'Nant-y-Gwyddon effect', is also described.