Government In England Research Articles

The role of specialist nurses for organ donation: A solution for maximising organ donation rates?

To explore the role that Donor Transplant Co-ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN-ODs), within organ donation strategies in the UK and other countries. Organ donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt-out system of organ donation, in line with the Wales change. This discursive paper explores the role from Donor Transplant Co-ordinator to Specialist Nurse in Organ Donation (SN-OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation. The current scope and future potential of Donor Transplant Co-ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation. There is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation.

Theatre and Governance in Britain, 1500–1900: Democracy, Discourse and The State by Tony Fisher

Reviewed by: Theatre and Governance in Britain, 1500–1900: Democracy, Discourse and The State by Tony Fisher Jim Davis THEATRE AND GOVERNANCE IN BRITAIN, 1500–1900: DEMOCRACY, DISCOURSE AND THE STATE. By Tony Fisher. Cambridge: Cambridge University Press, 2017; pp. 290. Tony Fisher's monograph provides a new and original way of looking at the relationship between theatre and governance in Britain between 1500 and 1900. Through a series of case studies and an ongoing analysis of the philosophical basis for the perspectives he examines, he untangles the complex relationship between theatre and the state. While he covers familiar territory, he also offers new ways of reading Britain's theatrical past in a study that is well-grounded in both contemporary and historical discourses pertinent to the topics of government and theatre. In particular, he provides a valuable insight into Platonic notions of theatre and their impact on European thought. In Fisher's view, theatre was seen by government not only as a symptom of social corruption, but also as a potential instrument of reform. Consequently, as public theatres evolved alongside the expansion of the population in early modern Britain, so perceptions of the relationship between theatre and governance also changed. We move from the notion of theatrum mundi, wherein men and women are players on the stage of the world, to the "theatre of the multitude," focused more on the material conditions of everyday life. Within this context, Fisher suggests that anti-theatrical prejudice has less to do with puritan and moral opposition to the stage and is based more on a fear of disorder, sedition, and the instability and potential idleness of the common people. Insofar as theatre calls into question the authority of government by questioning the legitimacy of social and political order and hierarchy, it therefore represents the growing self-assertion of the laboring classes and their right to leisure. Thus two notions of community are at loggerheads: an ordered, unified community on the one hand, and a community of individuals (the multitude) on the other. The discourses around the threat of the [End Page 401] multitude and the threat of theatre coalesce, indicating the necessity of political governance over both common life and theatre. As new forms of power emerge in the late 1600s, the Restoration stage comes to represent an important moment in the development of theatre's relationship to governance in Britain. While anti-theatricalism, especially as represented by the opinions of Jeremy Collier, continues, freedom and conduct are more central to discourses of governmentality. In Restoration drama, this emphasis on freedom and conduct (and the possible tensions between them) is embodied by the character of the libertine, enabling a satirical emphasis on the public dimension of private conduct (in civil society rather than politics). Dramatists are not necessarily endorsing libertine conduct; rather, they could be seen as advocating appropriate governance (and self-governance) within the family through correct conduct. While Restoration comedy takes place in a predominantly upper-class milieu, it hints at the wider social consequences when liberty is not restrained by governance. Within this context, Collier's anti-theatricalism in this period can be seen as a social rather than moral critique of the theatre. In the early eighteenth century, as liberal governance absorbs the autonomous freedom of the individual, through various techniques of influence that curtail personal liberty, the question arises around the optimum license the theatre should be allowed within the public sphere. In his analysis of the events leading up to the Licensing Act of 1737, Fisher concludes that the emphasis is on keeping politics off the stage, and that the legislation aims to discipline rather than suppress theatre. Central to this discussion are the political satires of Henry Fielding, but whereas Fielding believed the stage should instruct through example and hold the powerful to account, the government believed that his satires, which often disparaged political figures, were a misuse of the stage. Fisher, however, suggests that another concern of the act was to regulate for appropriate behavior in the public sphere, and to prevent corruption and incivility among the lower orders. Prior to the act, the theatre was beginning to provide moral lessons in relation to...

Dickens and Wills: Voices from the Past

Dickens and Wills:Voices from the Past David Paroissien (bio) 'There is just one other [instruction to take], and no more,' [Mr. Boffin said to his lawyer]. 'Make me as compact a little will as can be reconciled with tightness, leaving the whole property to "my beloved wife, Henerietty Boffin, sole executrix." Make it as short as you can, using those words; but make it tight.' (Our Mutual Friend, Bk. 1, ch. 8, 92) Thus Noddy Boffin to Mortimer Lightwood, when their conversation takes a new turn. The "Golden Dustman" and the idle young barrister had met by appointment soon after the body of young Mr. John Harmon had been discovered, "floating in the Thames" (31). Before them lay a will removed from an iron box labeled "HARMON ESTATE" (88). By its provisions, Nicodemus Boffin, old John Harmon's former servant, had come into possession "of upwards of one hundred thousand pounds" as residuary legatee.1 Now, with all the forms of law having at length been complied with and the Harmon will proved and "moved, &c., and so forth," nothing remained except for the "eminent solicitor" to offer his congratulations. "'There are no estates to manage,'" Mortimer Lightwood, continued, "'no rents to return so much per cent. upon in bad times […], no agents to take the cream off the milk before it comes to the table.'" Without codicils and trusts the lucky legatee could run off with the money "'and take it […] to – say, to the Rocky Mountains," an unlikely option for Mr. Boffin, perceived by some as "an old fellow of rare simplicity." "'I beg your pardon,'" Lightwood hesitated, and felt his way, at some loss to fathom his client's notion, "'but professional profundity must be exact. When you say tight – '" To which Boffin swiftly responded: "'What I want is, to make it all hers so tight as that her hold of it can't be loosed'" (Bk. 1, ch. 8, 92–3). [End Page 7] As this exchange illustrates, the making and administering of wills have different uses. In real life, people engage solicitors, make wills and die and legatees inherit; in novels, characters follow suit although with generally more dramatic results, offering authors from Sir Walter Scott to E. M. Forster a range of narrative and thematic opportunities. Howard's End (1904) in fact serves as a coda for the genre. Howard's End, the house gifted to Margaret Schlegel by Henry Wilcox's first wife, Ruth, bestows neither wealth nor influence. "It is a retreat," writes John R. Reed, "a salvaged piece of England that is less real estate than it is homestead of the soul." With inheritance redefined as something "strictly internal," it becomes its own reward. "Ownership is in the heart of the beholder," Reed concludes, arguing that Forster's novel is the culmination of the inheritance convention. It avoids "the more wooden details associated with lost wills and laboriously traced genealogies," while making "the grand point that novels like Our Mutual Friend, Felix Holt and others sought to confirm" (287). Dickens knew the will business intimately, perhaps better than most Victorian novelists.2 Indeed, we might characterize his viewpoint as unique, an insider's familiarity with wills as the voice of troubled testators. A remark he made about the lack of public support for charities in England illustrates this. While such philanthropic institutions in the United States "are either supported by the State or assisted by the State," the Government in England offers "very little shelter or relief" beyond the jail or the workhouse. What little aid reached the poor came indirectly, primarily from wills capriciously made and badly executed. To support that contention – "The maxim that out of evil cometh good"3 – turn to "the records of the Prerogative Office in Doctors' Commons,"4 Dickens advised. Drawing on knowledge gained as a freelance shorthand reporter working at the Wills office, Dickens put the following case in American Notes. Suppose an immensely rich old gentleman or lady. Both are surrounded by [End Page 8] "needy relatives" and both vent their displeasure by making, "upon a low average, a will a-week." For the old gentleman, naming legatees presents an opportunity to...

Governing and commercialising early childhood education: Profiting from The International Early Learning and Well-being Study (IELS)?

This article examines why the government in England has signed the country up to taking part in the OECD’s new international assessment known as The International Early Learning and Well-being Study (IELS). The article highlights the role of IELS as a technology of neoliberal governance. Looking forward it considers how IELS may open up new business opportunities and spaces for profit for businesses in England and elsewhere. At present, IELS is a fledgling product, but it may in time further add to the explanatory and governing power of the OECD to steer national policy makers towards a homogenised educational future defined by the organisation. IELS is run and managed by the National Foundation for Education Research (NFER), a national not-for-profit research organisation. The article explores how this same not-for-profit organisation also won the remarkably similar early childhood English Baseline Assessment 2 worth £9.8 million. Finally, the article examines the possibility that, in the future, if IELS were to develop, the edu-business Pearson might be interested in IELS to add to its existing interests in global data governance for profit.

A Study on the Distribution of Authorities and Responsibilities to Appraise Records of Central or Federal Governments in Britain, the USA, Canada, and Australia

A Study on the Distribution of Authorities and Responsibilities to Appraise Records of Central or Federal Governments in Britain, the USA, Canada, and Australia

George Hanger: The Life and Times of an Eccentric Nobleman by Ian Saberton, and: The American Revolutionary War in the South: Re-evaluation from a British Perspective in the Light of The Cornwallis Papers by Ian Saberton

Reviewed by: George Hanger: The Life and Times of an Eccentric Nobleman by Ian Saberton, and: The American Revolutionary War in the South: Re-evaluation from a British Perspective in the Light of The Cornwallis Papers by Ian Saberton Paul E. Kopperman George Hanger: The Life and Times of an Eccentric Nobleman. By Ian Saberton. ( Surrey, Eng.: Grosvenor House Publishing, 2018. Pp. x, 260. $39.99, ISBN 978-1-78623-163-5.) The American Revolutionary War in the South: Re-evaluation from a British Perspective in the Light of The Cornwallis Papers. By Ian Saberton. ( Surrey, Eng.: Grosvenor House Publishing, 2018. Pp. viii, 102. $29.99, ISBN 978-1-78623-154-3.) Since its publication in 2010, The Cornwallis Papers, a six-volume collection edited by Ian Saberton, has joined the exclusive list of primary sources that scholars must consult if they wish to do serious research on the southern campaigns that concluded the American Revolution. The collection includes not only transcripts but also well-researched annotations and extensive commentary. Saberton has strong opinions on why the British effort in the Revolution failed. His perspectives are displayed in The Cornwallis Papers and again in the two works that are the focus of this review. The American Revolutionary War in the South: Re-evaluation from a British Perspective in the Light of The Cornwallis Papers is a slim volume consisting of eight essays, most of which have been previously published. Saberton's first essay, "Was the American Revolutionary War in the South Winnable by the British?," sets the stage for the rest and is, in essence, what the collection is about. On the subject of generalship, Saberton reserves his strongest criticism for Charles Cornwallis, which is to some degree ironic. The author notes in reference to General Henry Clinton, "wars are won, not by cautious, hesitant commanders, but by those who are prepared to take risks" (p. 13). Cornwallis was a risk-taker. In the southern campaign, he failed to achieve his objective and lost his army in the process. And of course, his reputation suffered for it, though his subsequent achievements in India and Ireland may vindicate him to some degree. Despite the outcome, Saberton argues, "Britain's grand strategy for reducing the southern colonies was at least in part sound," but it was undone by the planners' initial underestimate of the number of troops that would be required (p. 2). Fighting against a guerrilla movement complicated the British position [End Page 668] still further. As Saberton recognizes, the Patriots overwhelmingly won the propaganda war in the South. Tales of atrocities committed by British forces fed hatred of them and brought forth more volunteers for the partisans. Saberton asserts that the British move into Virginia should have been delayed; that in order to match the speed of the Americans, British infantry should have been converted to horse; that Cornwallis (whom he portrays as excessively lenient) should have, as a deterrent, followed Banastre Tarleton's lead by dealing more harshly with enemy forces and with disaffected elements generally; and that the British army in the South should have been consolidated, minimizing the use of detachments. If implemented, these initiatives, Saberton believes, would have made the war "winnable." His perspective is interesting, and military history thrives on such arguments, but, given the realities on the ground in 1780 and 1781, the most appropriate answer to the question of whether the British could have won the war in the southern theater is, almost certainly, no. They could have continued to occupy Charleston, South Carolina; Savannah, Georgia; and other strongholds, and Cornwallis's army might conceivably have been evacuated from Yorktown, Virginia—Saberton and other historians would add that it should not have been there to begin with—but in addition to the difficulties discussed by Saberton, there are two that he largely ignores, and both are material. First, there was the grand strategy of the government in Britain. By 1779 it had virtually given up on the American colonies, and, with France entering the war, it was focusing on home defense and on maintaining control of the British West Indies. While both Clinton and Cornwallis were begging for more troops, the government's...

Comparison On Sustainable Urban Landscape Management: Insight From Urban Green Space Governance In England, Malaysia And Singapore

In order to achieve high-quality urban landscape management, it is important to have a proper management system. Some developing countries are facing a decline of green spaces due to lack of proper management. This paper aims to identify best management practices and provide a comparison regarding the governance of urban landscape management in the context of three countries: England, Malaysia and Singapore. It also highlights the importance of establishing more appropriate programs in order to achieve the goal of sustainability. The findings show that good and proper planning as well as programs and activities in the local government system can enhance and increase urban green space in a landscape. The contribution of this paper is to increase the local authority’s knowledge of managing the landscape and decreasing the deterioration and decline of urban green spaces in a landscape.

Whatever happened to the North East? Reflections on the end of regionalism in England

Governance in the English regions has been undermined and weakened by recent structural changes. Although well established during the New Labour era, the regional level of governance in England did not survive the post-2010 process of institutional churn shaped by economic austerity and central government’s aversion to the regional level. This has subsequently led to rescaling to the sub-regional level and the introduction of devolution ‘deals’ involving new combined authorities with elected mayors. This article looks at the experience of North East England, where regional structures have been broken up and the region disempowered by such changes. It reviews what has happened to governance in the North East over the past 20 years and discusses why the dismantling of regional governance matters. While the region’s external relationships with central government are problematic, it is also argued that governance problems within the region are no less important and need reforming. Longitudinal research indicates that organisations providing public services in the North East have continued to be characterised by inadequate accountability, unrepresentative governance and lack of transparency. The combined effects of the devolutionary consequences of Brexit and the ineffectiveness of small-scale ‘devo-deal’ interventions mean that the ‘Regionalist case’ in England will need to be refashioned and restated. The article concludes by considering the case for reintroducing regional-level governance and points to ways of bolstering the accountability and effectiveness of this level of sub-national governance.

The British, the Tudeh party and the 1947 World Federation of Trade Unions’ visit: battle for labour reform in Iran

ABSTRACTAfter the British-Soviet occupation of Iran during the Second World War, Iran became the key battleground for the international labour movement. The plight of the workers had become an important political issue with the Iranian government in conflict with the socialist Tudeh party for leadership over the trade unions. The Labour government in Britain was also deeply interested in the matter but regarded the Tudeh as too dangerous and too aligned with the Soviet Union to be supported. Within this climate, the World Federation of Trade Unions (WFTU) made an official visit to Iran. With its international delegates, they represented different views over the Tudeh, which caused much conflict during the visit. This article sheds crucial light on this important visit and reveals how international the Labour questions were in Iran and how the WFTU visit brought the various tensions to light. This research will also show how the timing of the visit may have impacted on the removal of the Iranian strong-man Ahmad Qavam by the end of 1947. This work is of particular significance as it looks at the previously understudied role and interest of the British government on the Iranian labour.

Governance by targets and the performance of cross‐sector partnerships: Do partner diversity and partnership capabilities matter?

Research Summary: This study examines the effectiveness of targets as a tool for the contractual governance of cross‐sector partnerships. Applying a difference‐in‐differences methodology, we find that the use of explicit targets within performance contracts is an effective means for improving partnership outcomes, especially where partner diversity and partnership capabilities are high. Furthermore, we find evidence that target intensity is associated with stronger partnership performance. These findings suggest that contractual forms with explicit targets may be a particularly successful approach for enhancing the public value created by cross‐sector partnerships. A downward turn in performance following the removal of targets lends further support to this conclusion.Managerial Summary: Cross‐sector partnerships have become a vital means for creating value in pursuit of the public interest. In particular, the effective management of these partnerships is thought to hold the key to addressing the strategic and organizational challenges posed by major social and environmental issues, such as big data and climate change. In this article, we combine data on waste recycling from 2003 to 2014 with information on performance contracts between local cross‐sector partnerships and higher levels of government in England to quantify the impact of governance by targets on the performance of those partnerships. The benefits of target‐setting for partnership performance that we identify are even stronger when partner diversity is high and partnership capabilities are strong. We discuss the managerial and policy implications of our findings.

Mobilizing the “State Papers” of Empire: John Bruce, Early Modernity, and the Bureaucratic Archives of Britain

Abstract This article examines John Bruce’s vision of the bureaucratic archives of the British state and empire at the end of the eighteenth century. As Historiographer to the East India Company and Keeper of State Papers in the 1790s and early 1800s, Bruce used the archives of corporate and state government as sources of bureaucratic knowledge to justify and plan imperial and domestic policy. In this way, Bruce deployed a strategy of governance by the authority of “state papers,” rooted in early modern political practice, across imperial and domestic government. The demise of Bruce’s influence signaled the waning of this role of the archive as a technology of governance in Britain during the nineteenth century.

‘Who Is British Music?’ Placing Migrants in National Music History

In 2013, trucks and vans were driving across London, bearing the message ‘In the UK illegally? Go home or face arrest.’ These mobile billboards declared the number of arrests that had taken place ‘in your area’ in the previous week and provided a number to which people could text the message ‘HOME’ to initiate voluntary repatriation. In 2016, Theresa May, who had organised this scheme as home secretary, became prime minister, following the upheaval caused by the country's plebiscite to leave the European Union. One of the main strands of argument of the successful ‘Brexit’ campaign centred on the ‘deep public anxiety . . . about uncontrolled immigration’ and promised to reduce numbers of immigrants to the country. This desire to control the nation's borders continued to dominate the official soundscape of Britain's government. At the 2016 annual Tory conference, May endeavoured to draw clear lines on issues of belonging, territory, citizenship, and the fuzzy notion of British values, discursively excluding not only migrants, but also anyone with an international(ist) outlook from the national debate: ‘If you believe you are a citizen of the world’, she posited, ‘you are a citizen of nowhere.’

‘Unparalleled Opportunities’: The Indian Y.M.C.A.'s Army Work Schemes for Imperial Troops During the Great War (1914–1920)

ABSTRACTThe present article aims to contribute to the global history of the First World War and the history of ‘imperial humanitarianism’ by taking stock of the Indian Young Men's Christian Association's Army Work schemes in South Asia, Europe and the Middle East. The outbreak of the war was hailed by some American secretaries of the Y.M.C.A. working in India as presenting overwhelming opportunities for their proselytising agenda. Indeed, the global conflict massively enlarged the organisation's range of activities among European soldiers stationed in South Asia and for the first time extended it to the ‘Sepoys’, i.e. Indian and Nepalese soldiers serving in the imperial army. Financially supported by the Indian public as well as by the governments of Britain and British India, the US-dominated Indian Y.M.C.A. embarked on large-scale ‘army work’ programmes in the Indian subcontinent as well as in several theatres of war almost from the outset, a fact that clearly boosted its general popularity. This article addresses the question of the effects the Y.M.C.A.'s army work schemes had for the imperial war effort and tries to assess their deeper societal and political impact as a means of educating better citizens, both British and Indian. In doing so, the article places particular emphasis on the activities of American Y-workers, scrutinising to what extent pre-existing imperial racial and cultural stereotypes influenced their perception of and engagement with the European and South Asian soldiers they wanted to transform into ‘better civilians’.

Technocracy, the market and the governance of England's National Health Service

AbstractEngland's National Health Service, the fifth largest employer in the world, has become heavily influenced by expert authority and the market economy, which has had implications for accountability and the receptiveness of health decisions to stakeholder needs. One response has been the introduction of a range of regulatory provisions designed to facilitate effective governance and stakeholder engagement. These provisions are scrutinized using three conceptual devices: core accountability, social reporting and social learning. These devices have significant implications, as they enable technical experts to form closed communities, communicate among themselves mainly about economic and financial matters, and make decisions that aid the market without meaningful recourse to citizens. While technical experts are necessary to help manage complex areas, current arrangements reinforce an existing gap between economic and democratic values through hardened technocratic approaches to health care governance.

Why Symmetry may not be the Answer to the UK's Constitutional Unsettlement: A Response to Bruce Ackerman

AbstractIn this reply Michael Kenny identifies the distinctiveness of Ackerman's characterisation of Britishness and the case he makes for constitutional reform. But he queries the remedies that he advances and, in particular, the attempt to address the problem of asymmetry through a system of regional government in England. Kenny argues instead that any adequate approach to reform in this area needs to grasp the decline of existing forms of territorial statecraft in the UK and the specific character of, and underlying motivations for, the increasing sense of democratic self‐assertion among the English.

Rebalancing the central-local relationship: achieving a bottom-up approach to localism in England

AbstractRecent governments have introduced a plethora of reforms seeking to decentralise power to local government in England. Invariably, however, these have fallen short of stated objectives, leaving councils at the mercy of central supervision and with insufficient local autonomy. This paper explores the reasons underpinning this concern. It identifies a top-down approach to localism and considers the culture of centralism that persists as a consequence. It then discusses how a bottom-up approach might be achieved, exploring how political and legal mechanisms can protect councils from centralised interference in the future.

New development: Decentralizing governance in England—transport's key role

Transport holds the key to effective decentralization of responsibilities in England. But transport cannot be considered in isolation from other functions. It has close links with spatial planning and other environmental, economic and social activities and they must function together. Decentralization must take this on board for England as a whole. There should be combined authorities established throughout England that are viable and accountable to the areas they serve.

Performance measurement and benchmarking as “reflexive institutions” for local governments

PurposeThe purpose of this paper is to discuss different approaches of performance measurement and benchmarking as “reflexive institutions” for local governments in England, Germany and Sweden from a comparative perspective.Design/methodology/approachThese three countries have been selected because they represent typical (most different) cases of European local government systems and reforms. The existing theories on “institutional reflexivity” point to the potential contribution of benchmarking to public sector innovation and organizational learning. Based on survey findings, in-depth case studies, interviews and document analyses in these three countries, the paper addresses the major research question as to what extent and why benchmarking regimes vary across countries. It derives hypotheses about the impacts of benchmarking on institutional learning and innovation.FindingsThe outcomes suggest that the combination of three key features of benchmarking, namely – “obligation”, “sanctions” and “benchmarking authority” – in conjunction with country-specific administrative context conditions and local actor constellations – influences the impact of benchmarking as a reflexive institution.Originality/valueIt is shown in the paper that compulsory benchmarking on its own does not lead to reflexivity and learning, but that there is a need for autonomy and leeway for local actors to cope with benchmarking results. These findings are relevant because policy makers must decide upon the specific “governance mix” of benchmarking exercises taking their national and local contexts into account if they want them to promote institutional learning and innovation.

Models for University Government

The author looks at current practices of university government in Britain, Canada and Germany and pinpoints some issues raised by recent proposals for administrative and constitutional changes in universities. He suggests that Canadian social scientists could help resolve some of these issues by systematically sorting out and objectively appraising these proposals.

The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England.

Background: The Liverpool Care Pathway for the Dying Patient ('LCP') was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review. Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice? 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the 'boundary object' concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the 'evidence' required to underpin innovations in palliative care and became a conduit of discord about 'good' or 'bad' practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.