English Local Authorities Research Articles

Reversing the pipeline? Implementing public health evidence-based guidance in english local government

BackgroundIn the UK, responsibility for many public health functions was transferred in 2013 from the National Health Service (NHS) to local government; a very different political context and one without the NHS history of policy and practice being informed by evidence-based guidelines. A problem this move presented was whether evidence-based guidelines would be seen as relevant, useful and implementable within local government. This study investigates three aspects of implementing national evidence-based recommendations for public health within a local government context: influences on implementation, how useful guidelines are perceived to be and whether the linear evidence-guidelines-practice model is considered relevant.MethodsThirty-one councillors, public health directors and deputy directors and officers and other local government employees were interviewed about their experiences implementing evidence-based guidelines. Interviews were informed and analysed using a theoretical model of behaviour (COM-B; Capability, Opportunity, Motivation–Behaviour).ResultsContextual issues such as budget, capacity and political influence were important influences on implementation. Guidelines were perceived to be of limited use, with concerns expressed about recommendations being presented in the abstract, lacking specificity and not addressing the complexity of situations or local variations. Local evidence was seen as the best starting point, rather than evidence-based guidance produced by the traditional linear ‘evidence–guidelines–practice’ model. Local evidence was used to not only provide context for recommendations but also replace recommendations when they conflicted with local evidence.ConclusionsLocal government users do not necessarily consider national guidelines to be fit for purpose at local level, with the consequence that local evidence tends to trump evidence-based guidelines. There is thus a tension between the traditional model of guideline development and the needs of public health decision-makers and practitioners working in local government. This tension needs to be addressed to facilitate implementation. One way this might be achieved, and participants supported this approach, would be to reverse or re-engineer the traditional pipeline of guideline development by starting with local need and examples of effective local practice rather than starting with evidence of effectiveness synthesised from the international scientific literature. Alternatively, and perhaps in addition, training about the relevance of research evidence should become a routine for local government staff and councillors.

Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

ABSTRACTThis paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern.

Music technology, education and maps: The use of geospatial technology and data to inform music education research

Abstract Recent developments in geographical information systems and geospatial statistics, together with greater access to large, fine-resolution ‘geocoded’ data sets, are transforming environmental, social and economic research. Over the past decade, there has been a small, but growing application of these techniques within the fields of music making, music education and music research. This article begins by offering a brief overview of some of the developments as a whole. It goes on to offer a detailed treatment of a series of geospatial statistical techniques which, it is hoped, may be applicable within a wide range of music and music education research fields. These techniques are illustrated through references to a deviant idiographic case study dealing with instrumental tuition provided by one English local government area (local authority) between 2003 and 2010. The case study draws on analyses of detailed anonymized participant records (n = 6063) using, amongst other techniques, location quotients, tests for spatial autocorrelation and distinct distributions and ‘global’ and ‘local’ regression models. The article will demonstrate how these techniques can be applied using open-source software and freely available census, government and cartographic data.

LIBERALISM, LOCAL GOVERNMENT REFORM, AND POLITICAL EDUCATION IN GREAT BRITAIN AND BRITISH INDIA, 1880–1886

AbstractThis article attempts to shed new light on the character of late Victorian Liberalism by investigating its political priorities in British India. It takes as its particular focus the debates which raged between 1881 and 1883 over the Government of India Resolution on Local Self-Government. Along with the Ilbert Bill, the Resolution comprised the centrepiece of the marquis of Ripon's self-consciously Liberal programme for dismantling Lytton's Raj. When analysed in conjunction with contemporaneous Liberal discourse on English local government reform, the debates surrounding the Resolution help to clarify many of the central principles of late Victorian Liberalism. In particular, these debates emphasize the profound importance of local government reform to what one might call the Liberal project. Beyond its utility in effecting retrenchment, efficiency, and ‘sound finance’, local government reform was valued by Liberals as the best and safest means of effecting ‘political education’ among populations, in both Britain and India, with increasingly strong claims to inclusion within the body politic.

Budgetary Stewardship, Innovation and Working Culture: Identifying the Missing Ingredient in English and Welsh Local Authorities’ Recipes for Austerity Management

AbstractDrawing on fieldwork with 70 local authorities in England and Wales, this paper builds on previous studies of austerity management by highlighting the importance of organisational cultures to achieving strategic objectives. It finds that, in line with their prevailing ‘belief system’ of budgetary stewardship, local authorities in both countries are holding down input costs to deal with austerity. However, the scale of funding cuts means that this strategy is unlikely to be successful over the longer term. Instead, they need greater freedom to generate revenue, in order to facilitate innovation and develop more sustainable business practices and service models.

The Search for Viability: A practitioner's view of how the Viable Systems Model is helping transform English local government (and why it has passed unrecognised)

Since 2010, local authorities in England have experienced an unprecedented reduction in their resourcing at a time when demands on services have risen substantially through social and demographic changes. Faced with such external challenges, various Councils' internal transformations have sought to change the organisation as a system, but also to alter the relationship with the environment. These have clearly been attempts to create viable systems, but have not been explicitly termed as such. This paper outlines a series of transformation interventions that have used the principles of the viable systems model to improve business governance and make evident the criticality of the effective functioning of Systems 2–5 of the viable systems model. The paper also considers why, when such individual transformations have evidentially supported the viability of local authorities, systemic thinking has not yet been embraced by the sector to improve its governing business systems. Copyright © 2017 John Wiley & Sons, Ltd.

Management accounting, performance measurement and strategy in English local authorities

This paper analyses the results of an extensive survey of UK local government which explored the relationship between strategy, management accounting practices (MAPs), and performance measurement techniques (PMTs). The research investigated a resource-based view of strategic capabilities and Porter’s strategic typologies. PMTs and MAPs were shown to be associated with strategic capabilities. Strategic typologies, however, were found to be only weakly associated with the use of PMTs and MAPs.

The quiet return of equalization alongside incentive in the English local government finance system

Local authority retention of 50% of business rates revenue was introduced in England in 2013–14, to be increased to 100% in the next few years. This signalled a move away from formula-based grant funding towards a funding system based on economic incentives. However, the 2016–17 settlement includes adjustments that indicate that equalization imperatives remain part of the policy toolkit. Given the complexity of the influences on local authority funding, these could maintain a considerable role when the new system is introduced.

Multi-level governance in the EU and EU democracy: Democratic legitimacy, democratic accountability and transparency of the European offices of the English local authorities in Brussels

ABSTRACTThis paper seeks to examine the role and functions of the representative offices of English local authorities in Brussels by considering the democratic legitimacy (i.e. linkage to elected councillors or mayors), accountability and transparency of the office’s activities. The study demonstrates that the offices differ in their governance arrangements and funding, which has a direct impact on the approach to democratic legitimacy and accountability, noting that those offices which rely most heavily on direct funding from a single authority or a combined authority have the closest links to the authorities concerned. The transparency of the offices varies considerably, with clear distinctions between offices that are creatures of contract or where offices are an emanation of the authority concerned. The pattern here is less dependent on the pattern of funding of the office and depends more on the availability of resources and the approach adopted by the office itself.

What about Financial Sustainability of Local Government!—A Critical Review of Accountability, Transparency, and Public Assurance Arrangements in England during Austerity

ABSTRACTAusterity strained the financial sustainability of governments and ability of policy-makers to address policy challenges, and so having appropriate accountability and transparency arrangements to assure the public they were getting value for money took on renewed urgency. Comparing and contrasting findings from a critical review of policy developments in English Local Government during the Conservative led coalition central government 2010–2015 with those from related studies on accountability and transparency more generally, the article offers key themes for practitioners and policy-makers seeking to build stronger democratic systems of governance that go well beyond the UK jurisdiction.

Estimating gonorrhoea prevalence in young heterosexual men and women attending community-based sexual health services to inform decisions on gonorrhoea testing.

In England, dual tests detecting chlamydia and gonorrhoea are used in specialist and community-based sexual health services (SHSs). Test performance is poor when prevalence is low, therefore UK national guidelines recommend against opportunistic gonorrhoea screening unless there is a clear local public health need. While surveillance data on gonorrhoea prevalence is comprehensive in specialist SHSs, it is sparse in community SHSs. We aimed to estimate gonorrhoea prevalence in heterosexual men and women aged 15-24 attending community SHSs to inform testing care pathways. We used linear and quadratic regression to model the relationship between prevalence in community and specialist SHSs in local authorities (LAs) with available surveillance data. We applied best-fitting models to predict prevalence in community SHSs in remaining LAs. Data from community SHSs were available for 102/326 LAs. There was a weak positive association between gonorrhoea prevalence in community and specialist SHSs in corresponding LAs within (R 2 = 0·13, P = 0·058) and outside (R 2 = 0·07, P = 0·02) London. Applying best-fitting models, we estimated a median gonorrhoea prevalence of 0·5% (mean 0·6%; range 0·2%-2·7%) in heterosexuals attending community SHSs. Despite some unexplained variation, our analyses suggest gonorrhoea prevalence in young heterosexuals attending community SHSs is below 1% in most English LAs. Our findings re-inforce the current national guidelines that recommend care pathways for gonorrhoea testing in community SHSs include confirmatory testing to reduce the risk of misdiagnosis and inappropriate management.

Working with the whole family: What case files tell us about social work practices

AbstractPractice theories to support child protection social work in the United Kingdom, as in the United States and Australia, are being squeezed out by a focus on performance targets and procedural timescales. This study examines an innovative programme designed to reverse this trend initiated by an English local government authority. The programme aimed to embed systemic family practice in situations where children are deemed to be at risk of harm. The findings, derived from an analysis of a case file sample, indicate that the social worker interaction with family members is predicated on who is living with the child in conjunction with the risk status of the case file. Conversely, practitioner interactions with family members are divorced from family structure and the lived experiences of kin relationships. This study concludes by examining why, despite training in systemic family practice, it was problematic for social workers to integrate it into their encounters with families.

Big change, little change? Punctuation, increments and multi-layer institutional change for English local authorities under austerity

ABSTRACTThis paper draws on new institutionalist theories to consider how we might characterise the process and outcomes of change occurring in English local government as a result of the UK’s austerity policies. It uses national and local empirical data to argue that changes are best understood as multi-layer processes, whereby radical ‘punctuated’ shifts in national funding can be mitigated to incremental adjustments in service delivery at a local level. However, the paper also suggests that the incremental appearance of change may be temporary, and that diminishing institutional resilience and emergent discursive shifts potentially prefigure a paradigm change in local governance.

How do empty signifiers lose credibility? The caseof commissioning in English local government

ABSTRACTThis paper critically analyzes how empty signifiers – demands which have been ‘tendentially’ emptied of meaning to represent an infinite number of demands – gain and lose credibility. I mobilize Laclauian discourse theory and a logics of critical explanation approach to examine the case of an English County Council and its Local Strategic Partnership (LSP) articulating ‘commissioning’ as an empty signifier in its new reform to address the Government’s post-2010 austerity agenda. The research characterizes how empty signifiers become formulated by discourses, gain appeal and lose credibility, demonstrating how such ‘universal’ demands require constant work from strategically placed individuals to avoid drifting into floating signifiers, i.e. becoming disputed. The paper makes two contributions: first to our understanding of how empty signifiers lose credibility; second, via its mobilization of concepts of empty and floating signifiers within a case study, into how ‘national’ signifiers such as commissioning have been mobilized by local authorities in diverse ways since the 2008 financial crash.

Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas.

ObjectivesReducing health inequalities is an explicit goal of England’s health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions.MethodsWe used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age–sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions.ResultsData on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in inequality.ConclusionsLocal equity performance in reducing inequality in emergency admissions varies both geographically and over time. Identifying this variation could provide insights into which local delivery strategies are most effective in reducing such inequalities.

Assessing the feasibility of using health information in alcohol licensing decisions: a case study of seven English local authorities

BackgroundIn 2011, local authority Directors of Public Health were designated as one of the responsible authorities for all alcohol licensing decisions in England. Since there is no explicit licensing objective around health, any representations need to be based on the existing objectives oriented around public safety, prevention of nuisance, child protection, and crime prevention. We aimed to appraise the benefits of an analytical support package developed by Public Health England in facilitating the use of health-related information in local licensing decisions and the prospects for a dedicated health-related licensing objective. MethodsA case-study methodology was used to invite nine local authority pilot areas to participate (one declined) on the basis of broad geographical representativeness across English regions and qualifying criteria that included a dedicated public health lead for alcohol licensing. Each participant was provided with an analytical support package consisting of a compendium of health-relevant data, local mapping software, and guidance on setting up data-sharing agreements. Key informants, including those in public health and licensing, were interviewed at baseline and after 8–12 weeks. Three mock licensing hearings, in which hypothetical licence applications involving health-related evidence were assessed by a panel, were conducted during the intervention phase. Follow-up focus group interviews involved a total of 31 informants across seven sites. A quantitative assessment of licensing activity was derived from Home Office statistics. FindingsPerceived difficulty in proving that a new licence would have a damaging impact on health had the effect of discouraging objections from public health teams. Obtaining timely access to localised health information was often problematic. There was also a degree of mismatch between the predominantly data-oriented approach by public health teams and the need for contextualised evidence for presentation to councillors. Early findings, however, demonstrated that several local authority areas were able to overcome these issues by incorporating novel indicators of health harm and using the mapping tools as a way of engaging their licensing committee. InterpretationConstraints around the more effective use of health information in the alcohol licensing process are not restricted to the presence or absence of a dedicated health-related licensing objective. Although such an objective might enhance the legitimacy of a role for public health, more streamlined access to localised health information, stronger collaborative working with other responsible authorities, and training in how to contextualise evidence will be crucial to improving local alcohol harm reduction through licensing. FundingThe evaluation was funded by Public Health England and commissioned as part of an ongoing programme of work around alcohol licensing and public health.

Improving population levels of physical activity through integration into everyday life: a before and after analysis of the Cycling City and Towns programme

BackgroundPopulation levels of physical activity are far too low to maximise health. In 2008, the Cycling City and Towns (CCT) programme was instigated across 12 cities and towns in England with the aim to get more people cycling “more often, more safely” through a whole-town approach to cycling. The aim of this study was to assess the effect of CCTs on utility (transport) cycling and other types of physical activity. MethodsIn this quasi-experimental study, population cycling and other physical activity behaviours in CCTs were compared with that in their closest corresponding city and towns, as defined by the Office for National Statistics (ONS). Data were taken from the annual Active People Survey, a geographically representative survey of all English local authorities with about 165 000 respondents providing information on their utility cycling, sport, and active recreation behaviours in the past 28 days. Logistic regression was estimated to identify the effect of CCTs on utility cycling and sport or active recreation, allowing for the potential interaction effects of time trends in national cycling prevalence. FindingsA general decline in cycling for transport purposes was observed in both areas. With adjustment for time trends and other confounding, CCTs were associated with an increased probability of transport cycling compared with comparison areas (odds ratio 1·48, 95% CI 1·14–1·94). The effect of CCTs on other forms of physical activity was not significant (0·94, 0·84–1·04). The male population, individuals aged 16–34 years, and people in the ONS socioeconomic category NS SEC 9 were most likely to have cycled. Those least likely to cycle were those in categories NS SEC 5–8 and of Asian ethnicity. InterpretationDespite the decline in transport cycling nationally, CCTs appear to be an effective intervention to promote cycling for transport purposes. Importantly, this effect does not seem to have come through a substitution of physical activity undertaken through sport or active recreation. However, more research is needed to address some limitations of our analysis, specifically the unobserved differences between areas obtaining CCT funding and other regions. FundingNone.

Do cumulative impact zones reduce alcohol availability in UK high streets? Assessment of a natural experiment introducing a new licensing policy

BackgroundThe Licensing Act 2003 enables English local authorities to implement Cumulative Impact Policies (CIPs). CIPs strengthen the powers of local authorities to reject licence applications for retail alcohol sales in cumulative impact zones (CIZs), where adverse effects of alcohol availability can be demonstrated. We assessed the impact of a CIP in one London borough on granting alcohol sales licences for off premise (off-licence) and on premise (on-licence) consumption and on the trading and closing times of premises. MethodsWe conducted a time-series analysis using Poisson regression of licensing data from April 1, 2008, to July 31, 2015, to estimate immediate and longer-term impacts of introducing CIP in 2013. Primary outcomes were number of licence applications, proportion of applications granted (success rates), and trading and closing times of licensed premises within and outside CIZs. Models were adjusted for overdispersion and underlying seasonal and secular trends, and checked for autocorrelation. In sensitivity analysis we examined the impact of CIP on outcomes in CIZs controlling for underlying trends in non-CIZs. FindingsThere were 409 and 278 alcohol licence applications for off-licences and on-licences, respectively. There was no significant impact of CIP introduction on number of applications submitted, or on trading and closing times of premises between areas or over time. There were statistically significant impacts immediately after CIP introduction of reduced application success rates in CIZs (−27·80%, 95% CI −42·33 to −9·60) and outside CIZs (−47·12%, −64·72 to −20·74) mostly driven by decreases in success rates for off-licence applications (−39·56% [–56·40 to −16·23] and −52·18% [–71·06 to −20·99], respectively). Subsequent years showed that application success rates for all licences increased in both areas (4·17% [0·43 to 8·05] and 13·64% [6·43 to 21·34], respectively). We found little evidence of CIP impact on primary outcomes in CIZs when controlling for non-CIZs. InterpretationAlthough CIPs led to short-term decreases in rates of alcohol licences granted, these reductions were not sustained. Previous research proposed that CIPs mainly affect premise type and licence conditions (eg, opening hours) rather than number of premises. Further research should explore these other potential impacts and whether non-CIZs are affected by spillover effects from CIZs. FundingNational Institute for Health Research (NIHR) School for Public Health Research.

Constructing pride, shame, and humiliation as a mechanism of control: A case study of an English local authority child protection service

This paper reports on findings from the first study into the role of self-conscious emotions in child protection social work practice. This ethnographic case study employed constructionist grounded theory methods to develop a conceptual understanding of the emotional experiences of the social workers. Integrating data from 246.5h of observations, 99 diary entries, 19 interviews, and 329 pages of documents, a conceptual framework is presented to understand the emotional experiences of the social workers, before using this framework to analyse the case organisation and experiences of those within it. Pride, shame, and humiliation can be considered to be strategically used as a mechanism of control by constructing contextually specific boundaries for shameful and praiseworthy behaviour. By policing these boundaries the actions of the organisation and the social workers could be regulated to ensure they developed institutionally acceptable identities, enabling the organisation to gain legitimacy. While the analysis that has been provided here is specific not only to the organisation that the research took place in, but also to the time in which the data were collected within the organisation, case studies provide important insights into one context that can be useful to understand the processes in others.

Audit committee roles and responsibilities in two English public sector settings

Purpose This paper aims to conduct a comparative study by examining the Audit Committee (AC) set-up, roles, responsibilities and developments in two distinct English public sector settings, namely, foundation trusts (FTs) and local authorities (LAs). Design/methodology/approach The paper is exploratory and explanatory in nature and uses a qualitative case study approach framed in institutional theory. It is based on semi-structured interviews with AC chairs, external and internal auditors and finance directors triangulated with meeting observations and documentation review. Findings The study finds that public sector ACs have a large and diverse role which extends beyond challenging/monitoring responsibilities. Influenced by the New Public Management ideology, the AC has developed more rapidly in FTs due to imposed regulation contrasting with the slower progress in LAs due to its still voluntary adoption. Nevertheless, in both environments, there is a developing understanding and growing competence within the AC in terms of their assurance role where the focus has shifted from an emphasis on function and on transacting business through following a manual, to a more strategic-looking approach. Research limitations/implications Due to the complexity of public sector settings, and by using an approach framed within institutional theory, the study contributes by challenging a simple notion of isomorphism as an explanation of AC roles, responsibilities and development in two distinct public sector environments. Furthermore, the study recognizes that there is a need to ensure ACs are appropriate to their institutional setting and organizational context. Originality/value Most AC studies have focused on private sector contexts. This paper explores the phenomenon in a different organizational context, namely, as a public sector comparative case study.