Deliveries In England Research Articles

Career development and older people

This article explores career development support offered to, and used by, older people since 2000. The context includes changes in age discrimination legislation and state pension entitlement, which intertwine in their effect on labour market participation. Career development services have changed, with a marked divergence between the fragmented delivery in England and the all-age services elsewhere in the UK. Initiatives have been piloted, judged successful, but not robustly pursued. The article argues that rhetoric outruns resources and delivery, and contemplates the additional complication of the impact of the Covid-19 pandemic on older people and the economy.

Deterioration, drift, distraction, and denial: How the politics of austerity challenges the resilience of prison health governance and delivery in England

Extant scholarship has demonstrated that macroeconomic austerity disproportionately harms marginalised end-users. Its impact on the governance and delivery of health provisions on such individuals, however, has received less attention. Drawing on interviews with 27 policy elites involved with England’s prison health policy, interviewees perceive that austerity policies have shaped and constrained the prison health system through the politics of deterioration, drift, distraction, and denial. The deterioration of the prison workforce size has been linked to diminished prisoner access to healthcare, attendant with an increased number of riots, assaults, acts of self-harm, and suicides. Concurrently, the microeconomic structure of organised crime is filling the void in prison governance, thus conducing to heightened abuse of psychoactive substances, as well as a surge in associated medical emergencies and violence. Successful prosecution of prior sexual offences, continued incarceration of those imprisoned for indeterminate sentences, and harsh sentencing practices have created policy drift, unremitting overcrowding, and reinforced excessive dependency on prison healthcare resources. The rapid turnover of justice ministers and intensified push for prison privatisation have enabled widespread distraction. Moreover, despite well-documented crises besetting English prisons, politicians seemingly remain in a state of denial. Preventive imprisonment, recurrent spending, and enhanced financial and political accountability measures are necessary to mitigate the effects of austerity and germane policies fomenting inimical impacts on England’s prison health system.

Guidance for the Treatment and Management of COVID-19 Among People with Intellectual Disabilities.

The current COVID‐19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID‐19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID‐19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS‐CoV‐2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID‐19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID‐19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.

An assessment of Voluntary Travel Behaviour Change delivery in England as an alternative to highway construction

There is a growing body of international evidence available that shows highway construction fails to solve issues of congestion and improvements to the local economy. There is also evidence that due to changes of land use and expectations of being able to travel from the land opened for development that traffic is induced to the highway network. Alternative methods of managing travel demand; such has Voluntary Travel Behaviour Change (VTBC) initiatives have been delivered internationally. A significant VTBC scheme, called the Local Sustainable Transport Fund (LSTF), was delivered in the United Kingdom between 2011 and 2015. This paper focuses on the people who delivered these initiatives, rather than the individuals required to change their behaviour. This is to understand how transport planners’ views influence the type of VTBC initiatives that were delivered. The study included a survey of 69 bid managers for LSTF projects and interviews with 17 council officers. The survey found that 80% transport planning officers understood the concept of induced traffic compared to just 10% of the wider population. It was also evident that the sample group was a homogenous group, where their views on issues such as climate change, congestion and the factors that influence how we travel were remarkably similar. The findings show that despite the evidence that highway construction does not provide a solution to travel demand, the decisions about which schemes are funded remain with non-transport experts, such as government ministers and local politicians, and this invariably leads to highway ‘solutions’ being chosen which limit the potential success of any VTBC initiative to create long-term change to travel behaviour.

The role of pharmacists in general practice: A realist review.

The review was carried out to inform the evaluation of the clinical pharmacists in general practice pilot scheme, a world leading initiative to improve health care delivery in England. Around 500 pharmacists are already working in general practice as part of the pilot, launched in July 2015. The review attempts to explain the how pharmacists working in general practice is being implemented in the UK and beyond, what works well, what does not work so well and everything in-between. This realist review was conducted to the RAMESES standards. Studies were identified by searching three databases, Medline, Embase and Scopus. Additional papers were gathered from reference lists, Google searches and via the find similar citations feature. A total of 83 papers and articles were initially identified from Medline (19), Embase (31) and Scopus (32). With close reading, the final review consisted of 43 papers relating to 38 studies. Most of the research was undertaken in the field of pharmacy practice and over half of the studies investigated the perspectives of different stakeholders using questionnaires or qualitative methods. The pharmacist working in general practice is still a relatively new concept and further more in-depth research is still required. However, from this small number of studies, the common barriers and facilitators to the implementation can be identified. The review also lists mechanisms that will be needed to ensure the effective implementation of this initiative.

Recent developments in police governance and current issues surrounding police service delivery in England and Wales

Recent developments in police governance and current issues surrounding police service delivery in England and Wales

Explaining reforms: post-New Public Management myths or political realities? Social housing delivery in England and France

This article examines the assumption that recent reforms in social and public services can be understood as a transition from New Public Management to post-New Public Management. English and French social housing delivery are selected as two cases in which to test out this assumption, for ostensibly these delivery structures share significant cross-national, post-NPM similarities – a movement towards a more ‘enabling’ or steering role for central government, the creation of coordinating agencies, ‘decentralization’ initiatives, the extensive use of public–private arrangements to finance social housing and the involvement of a wide range of extra- and semi-governmental organizations. However, further investigation reveals that these reforms of delivery structures have not been predominantly driven by an unfolding post-NPM managerial or governance logic as the thesis assumes. Rather the reforms have been driven by the partisan electoral and ideological goals of central government policymakers within the context of institutional legacies and entrenched social values. Points for practitioners New Public Management and post-New Public Management have become the conventional wisdom on administrative reforms particularly in a comparative context. This article argues that these ideas reflect an impoverished understanding of public administration given that they assume that change occurs predominantly through the unfolding of managerial and/or governance logics. These logics exclude the critical role of the political parties and other socio-political factors, such as urban unrest, in driving change. This Anglo-French analysis of social housing delivery demonstrates the significance of these political factors in how policymakers define social problems, re-design and implement social housing service delivery systems.

Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

ObjectivesTo describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision...

Contracting out parks and roads maintenance in England

Purpose – Different models have been adopted in England over time to organise public service delivery. The purpose of this paper is to explore contracting-out, a prevalent model of public service delivery in England, in relation to parks and roads maintenance delivery by examining private contractors’ performance according to local authority stakeholders. Design/methodology/approach – Since the Conservative Government was in power during the 1980s, local authorities have been an arena for experimentation of contracting-out to private and other sectors. This paper provides a review of the academic and grey literature, and findings are presented from a large-scale online questionnaire survey (n=103) which was distributed to the relevant public realm managers in English local authorities. Findings – The paper shows that contracting-out of parks and roads maintenance happens across the country in different ways. By and large, local authorities are satisfied with the performance of contractors, particularly as a response to economic constraints. Responsibilities, particularly for parks, are increasingly shared with non-governmental organisations, including community groups, although this is not reflected in budget distribution. Research limitations/implications – Despite the efforts, the response rate was relatively low (32 per cent), potentially due to the e-mail communication and online nature of the questionnaire. Originality/value – The research provides empirical evidence about how contracting-out is currently delivering public services and how it has changed in recent years. The findings suggest that responsibilities (and to a lesser extent, budgets) are increasingly shared in England between different combinations of public, private, third and community sector stakeholders. This marks a shift away from in-house public sector delivery of parks and roads services.

A Concept Analysis of Spirituality in Occupational Therapy Practice

Health policy and high profile investigations about poor care delivery in England emphasise the need for health professionals to ensure care is patient-centred, addressing each individual's physical, emotional, social and spiritual needs. Person-centred practice, valuing the uniqueness of the individual, is central to the philosophy of occupational therapy. Spirituality is a key dimension of person-centredness but how to address it in everyday practice remains a challenge. This article reports on a concept analysis which was undertaken to explore the empirical referents of addressing the spiritual as a means of guiding practice, and the antecedents and attributes underpinning spirituality as a dimension of occupational therapy practice. A range of health-related databases were searched from 2000 to 2013. Eight studies that focused on spirituality and occupational therapy practice were included in the concept analysis. Spirituality in occupational therapy practice was found to be associated with a holistic, person-centred approach to care. It aimed to restore a sense of wellbeing and to recognise individual coping strategies. A framework was developed to operationalise spiritually competent care for occupational therapy practice. The study concluded that occupational therapists respond to a disruption in wellbeing and quality of life by mobilising patients’ spiritual coping strategies in order to support and restore the patient's sense of meaning and purpose.

Is Delivering on the Weekend Dangerous

Do obstetric outcomes vary by day of the week? To answer this question, investigators studied 1,332,835 deliveries in England from 2010 to

A survey of major trauma centre staffing in England

IntroductionTrauma care delivery in England has been transformed by the development of trauma networks, and the designation of trauma centres. A specialist trauma service is a key component of such...

Ethnic variation in stillbirth risk and the role of maternal obesity: analysis of routine data from a London maternity unit.

BackgroundApproximately 5 in 1,000 deliveries in England and Wales result in stillbirth, with little improvement in figures over the last few decades. The aim of this study was to investigate the association between clinical and socio-demographic factors and stillbirth, with a particular focus on ethnicity and obesity.MethodsAnalysis of routine maternity data on 53,293 singleton births occurring in a large London teaching hospital between 2004 and 2012. Logistic regression was used to investigate risk factors for stillbirth and to explore potential effect modification.Results53,293 deliveries occurred during the time period, of which 329 resulted in a stillbirth (6.2 per 1,000 births). Compared to White women, non-White ethnicity was associated with a doubling of the odds of stillbirth (aOR for Black women 2.15, 95% CI 1.56-2.97; aOR for South Asian women 2.33, 95% CI 1.42-3.83). Obese women had a trend towards higher odds of stillbirth compared to women of recommended BMI (aOR 1.38, 95% CI 0.98-1.96), though this was not significant (p 0.07). Both higher parity (≥2 compared to para 1) and hypertension were associated with a higher odds of stillbirth (parity ≥2 aOR 1.65, 95% CI 1.13-2.39; hypertension aOR 1.84, 95% CI 1.22-2.78) but there was no evidence that area deprivation or maternal age were independently associated with stillbirth in this population. There was some evidence of effect modification between ethnicity and obesity (p value for interaction 0.06), with obesity a particularly strong risk factor for stillbirth in South Asian women (aOR 4.64, 95% CI 1.84-11.70).ConclusionsThere was a high prevalence of stillbirth in this multi-ethnic urban population. The increased risk of stillbirth observed in non-White women remains after adjusting for other factors. Our finding of possible effect modification between ethnicity and obesity suggests that further research should be conducted in order to improve understanding of the interplay between ethnicity, obesity and stillbirth.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0404-0) contains supplementary material, which is available to authorized users.

Performance Management of the NHS' Mental Health Care Service Delivery in England: The Role of the Service' Actors' (Clients) Collaboration through Dialogism

A welfare state has a responsibility to provide health and social services to the citizenry. The state delegates that responsibility to a number of actors, each of which has its own performance management criteria. To ensure coherence, it is important to manage their performances collectively taking into consideration all the actors inputs rather than only that of government or its agent, the NHS. This turns out to be a difficult task especially that of the mental health care services. The author will be looking at a possible solution to this problem based on the assumption that it is possible to change the way the actors present their stories by bringing them together to share their purposes and common action through the notion of dialogism as way of maintaining plurality of logics: different voices (polyphonic), styles (stylistic), space-time conception (chronotopic), inter-animating discourse (architectonics) and the dynamic interplay of these different dialogisms (polypi). It is this process of plurality of logic that the researcher termed, the Third Cybernetics Evolution, as a way of sequential processes from the First Cybernetics through the Second Cybernetics to the Third Cybernetics. It is argued that implementing these, allows for improved communication among actors, as a way of achieving high quality service. It is suggested that implementation of these concepts and processes implies the use of storytelling as a facilitatory system. It is shown that all actors in the mental health care services delivery make use of this system, albeit often inefficiently. Therefore this may lead to dissipation of the system in the future. To prevent such dissipation, the existing structure needs to be improved through spiral relationships via communication and collaboration through dialogism. The paper aims at flagging the important role played by the weaker actors in collaboration with stronger actors in improving performance management of the NHS's mental healthcare service delivery through Actors-dialogism-system. The paper also focuses on proposition of a system to address issues affecting collaboration among the actors of the mental healthcare service in England.

How dementia and neurodegenerative disease clinical research networks have enhanced research delivery in England

In 2005 the Government established a clinical research network in dementia and neurodegenerative diseases to increase and improve research in an area of unmet need. Since its creation, the Dementias and Neurodegenerative Diseases Research Network (DeNDRoN) has facilitated a 300% increase in the number of the National Health Service trusts recruiting people to dementia and neurodegeneration research, a 500% increase in the number of open studies each year, and a 600% increase in the number of people taking part in studies. This article summarizes the increased activity and improvements in performance delivered since 2005; describes some of the people networks through which this has been delivered; and describes how the network is evolving as part of the reorganization of the National Institute for Health Research Clinical Research Network.

To what extent can evaluation frameworks help NGOs to address health inequalities caused by social exclusion?

Tackling health inequalities is a top priority for public health services in England. Third sector organisations, or non-governmental organisations (NGOs), are seen as having a key role in providing these services, particularly to the socially excluded, often dubbed 'hard to reach', for whom services must be provided if health inequalities are to be reduced. The plethora of evaluation frameworks available to NGOs have a variety of value bases, ranging from those which unambiguously support commissioners and providers to address health inequalities and work with the 'hard to reach', through to those which could offer such support if suitably adapted, to those that would struggle to address these issues in practice. In this context, the aim of this article is to answer the question, 'to what extent can evaluation frameworks help NGOs to address health inequalities caused by social exclusion?' The literature on health inequalities, evaluation frameworks, and the policy context within which NGOs deliver public health services, is briefly reviewed. We then draw on the concepts of 'comparative advantage' and the 'space of access' to explore the extent to which evaluation frameworks can help NGOs to address health inequalities caused by social exclusion. We identify contradictions between recent government policies around public service delivery in England which can make it difficult for service providers and commissioners to know which value(s) to focus on. This confusion is likely to at least perpetuate, perhaps even exacerbate, the marginalisation of socially excluded people, particularly in the current climate of austerity. The evaluation frameworks NGOs choose to use, and how they decide to use them, can have a real impact on health inequalities. We argue that, wherever possible, NGOs should place social value at the centre of the evaluation process, or at least make sure they capture as much as they can of the social value they create, in line with their own value base. Commissioners and providers do not always have a free choice about which evaluation framework to use, for example, due to resource constraints. Nevertheless, commissioners or providers can still influence evaluators to address health inequalities and involve the 'hard to reach'.

Comparing patient and professional views of expected treatment outcomes for chronic obstructive pulmonary disease: a Delphi study identifies possibilities for change in service delivery in England, UK

To clarify by consensus the professional and patient views of expected treatment outcomes for chronic obstructive pulmonary disease and to compare the similarities and differences and identify the potential for adjusting service delivery. Chronic obstructive pulmonary disease is an under-researched topic necessary to illuminate health planning, and patient partnership needs in the UK clinical screening is low priority for this condition. Government policy expects that service users are involved in planning services for their condition, but few opportunities exist for this process. A feasibility study in two phases conducted three service user focus groups and one specialist professional group to provide statements of expected treatment outcomes from chronic obstructive pulmonary disease interventions. The statements then formed a further two-round Delphi structured survey to compare service users' and carers' views with those of specialist professionals to ascertain what differences could be developed in service delivery for people with chronic obstructive pulmonary disease. Three rounds of Delphi survey were administered. Round 1: Specialist professionals and patients with chronic obstructive pulmonary disease ranked statements using nominal group technique. A nine-point scale Delphi consensus study used the statements in two further rounds. Twenty-four of 54 professionals contacted, and 52 of 152 patients and carers completed Delphi rounds 2 and 3. Consensus was found within and between both groups. The greatest difference was where professionals sought government targets and did not realise patient expectations, which were constrained by policy disincentives. The greatest agreement was for accurate record keeping and the need for revised chronic obstructive pulmonary disease services. Patients consider that services should support them to retain their independence and enable their adaptation to the condition. Health professionals aim to provide patient focused care based on need. This helps improve outcomes of interventions. Patients are willing and able if supported to increase independence and maintain self-help.

Variations in Radiotherapy Delivery in England — Evidence from the National Radiotherapy Dataset

Aims, Materials and methodData in the national radiotherapy dataset for England for 2009–2011 is based upon downloads of activity from every linear accelerator in the country through its oncology management system linked to the local patient administration system to give a full overview of each patient episode. ResultsAn analysis of this dataset shows that there is still a considerable variation in radiotherapy activity across the country, with a two-fold variation between the most and least active networks. Lower activity is seen in London and the southeast compared with the rest of the country, but when the data are split between the north and south of the country, no such variation is seen. Activity is higher in smaller centres and non-teaching centres. About half of all treatment is palliative and this proportion does not vary with geography, although there is considerable variation between individual centres in the proportion of radical radiotherapy given. There is a trend towards less use of radiotherapy, both radical and palliative, in the more deprived population groups, although no change in the relative use of palliative and radical treatment. ConclusionIt is important to emphasise that these data currently reflect activity patterns only and do not reflect quality of care or treatment outcomes, which will be achieved by linkage with cancer registry data in the future.

Delivering better end-of-life care in England: barriers to access for patients with a non-cancer diagnosis

The End of Life Care Strategy (Department of Health, 2008) radically raised the profile of end-of-life care in England, signalling the need for development in planning and delivery, to ensure that individuals are able to exercise genuine choice in how and where they are cared for and die. Research has indicated that there have been continuing difficulties in access to high-quality and appropriate support at the end of life, particularly for patients with a diagnosis other than cancer. This article uses research findings from three case studies of end-of-life care delivery in England to highlight some of the barriers that continue to exist, and understand these challenges in more depth. Access to high-quality and appropriate end-of-life care has been a challenge for all patients nearing the end of life. However, the findings from this research indicate that there are several interrelated reasons why access to end-of-life care services can be more difficult for patients with a non-cancer diagnosis. These issues relate to differences in disease trajectories and subsequent care planning, which are further entrenched by existing funding arrangements.

Limits to Growth: The Challenge of Housing Delivery in England's ‘Under-bounded’ Districts

In the UK, the outward growth of settlements beyond their existing territorial boundaries has until recently been managed primarily through local negotiation between neighbouring authorities or by the coordination and impetus provided by strategic planning. The current overhaul of the planning system in England, with the removal of regional planning, has unlocked a debate over how ‘larger than local’ planning is undertaken and how cross-boundary cooperation is promoted. This paper reports, firstly, on planning professionals' recent experience of cooperating on major housing developments in three under-bounded authorities. Secondly, it reflects on the loss of the regional tier, and thirdly, it examines expectations of a more locally oriented planning system and its likely capacity to deliver on major cross-boundary projects.