Local Authority Areas In England Research Articles

Zero tolerance to sexual harm in schools – from broken rules to broken systems

ABSTRACT In 2020, student disclosure of sexual harm through the website “Everyone’s Invited” reignited discussions of sexual harm in schools with many calling for “zero tolerance” approaches to sexual harm. This article considers the impact of zero tolerance policies drawing upon school policies and practices, coupled with students experiences. The article draws upon findings from a mixed-methods study conducted from 2018–2020 within four local authority areas in England: focus groups with staff and students, surveys with students and parents, case review, observations, and school self-assessments. Analysis evidenced that where schools drew on punitive and sanctions-based approaches these impacted student disclosure, limited staff decision making, and were not seen to be effective by students. Rather than zero tolerance policies, the findings evidence the need to: tackle environments where sexual harm is tolerated; consider systemic barriers to disclosure, and expand what justice means for responses to sexual harm in schools.

Spatial growth rate of emerging SARS-CoV-2 lineages in England, September 2020-December 2021.

This paper uses a robust method of spatial epidemiological analysis to assess the spatial growth rate of multiple lineages of SARS-CoV-2 in the local authority areas of England, September 2020-December 2021. Using the genomic surveillance records of the COVID-19 Genomics UK (COG-UK) Consortium, the analysis identifies a substantial (7.6-fold) difference in the average rate of spatial growth of 37 sample lineages, from the slowest (Delta AY.4.3) to the fastest (Omicron BA.1). Spatial growth of the Omicron (B.1.1.529 and BA) variant was found to be 2.81× faster than the Delta (B.1.617.2 and AY) variant and 3.76× faster than the Alpha (B.1.1.7 and Q) variant. In addition to AY.4.2 (a designated variant under investigation, VUI-21OCT-01), three Delta sublineages (AY.43, AY.98 and AY.120) were found to display a statistically faster rate of spatial growth than the parent lineage and would seem to merit further investigation. We suggest that the monitoring of spatial growth rates is a potentially valuable adjunct to outbreak response procedures for emerging SARS-CoV-2 variants in a defined population.

Navigating different public health roles in alcohol premises licensing: a multi-stakeholder interview study

BackgroundIn England and Scotland, local governments regulate the sale of alcohol through premises licensing. In the past 10 years, some public health practitioner teams have become proactive in engaging with alcohol licensing to encourage actions regarded as likely to improve population health. These public health teams are largely based in the National Health Service in Scotland, and within local authorities in England. This research explored ways in which public health actors believe their activities make a difference to alcohol licensing decisions, policies, and systems, and the acceptability of their involvement from licensing stakeholder perspectives. MethodsAll public health practitioner teams were directly informed about this multicentre study. Scoping calls were conducted with interested teams to explore their level of activity in alcohol licensing in 2012–19 across several pre-defined categories. Recruited local authority areas purposively varied by region and rurality. 53 in-depth telephone interviews (28 with public health actors and 25 with licensing stakeholders) were done in 20 local authority areas in England (n=14) and Scotland (n=6). Interview transcripts were analysed thematically with NVivo 12 using inductive and deductive approaches. FindingsMost public health actors felt that they could make a difference by broadening licensing decision makers' understanding of alcohol-related health harms. For many, a key motivation was to reduce harms through containing alcohol availability at current levels and, ultimately, long-term culture change. Others adapted their approach to fit with the aims of licensing staff, focusing on promoting responsible sale of alcohol, so-called responsible drinking, or both. In both cases, public health actors and licensing stakeholders viewed partnership working as key to effectiveness. Although most licensing staff valued public health involvement, a minority were sceptical about public health involvement focused on containing availability, considering this approach as too narrow in focus. Some public health actors felt unable to secure public health improvements within the constraints of current licensing systems, which have potential to prevent increases in alcohol availability but are unable to reduce alcohol availability. InterpretationPublic health actors take different approaches to engagement with alcohol licensing, including disruptive or collaborative approaches. Collaborative approaches were seen as more acceptable by some licensing stakeholders, but focus mainly on short-term outcomes other than health (eg, crime). The effectiveness of public health involvement, including through these different approaches, merits quantitative evaluation. Sampling did not include lower activity areas wherein experiences might differ. FundingThe ExILEnS study was funded by the National Institute for Health Research (project number 15/129/11). The views expressed in this work are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, or the UK Government's Department of Health and Social Care.

Community interventions for improving adult mental health: mapping local policy and practice in England

BackgroundPublic mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention.MethodWe adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers’ insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020.Results407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated.ConclusionsThere was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.

Home-care providers as collaborators in commissioning arrangements for older people.

In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non-statutory home-care providers (for-profit, not-for-profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home-care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi-structured telephone interviews with 20 managers of for-profit home-care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home-care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time-consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal-steward relationships in contracting.

Emerging problematics of deregulating the urban: The case of permitted development in England

Urban planning systems, processes and regulations are often blamed – by many mainstream economists – for constraining the supply of housing by interfering with the efficient allocation of land by the market and unnecessarily delaying development. In England, this orthodox view has influenced the government’s deregulatory planning reforms, including – since 2013 – the removal of the requirement for developers to apply for planning permission for the conversion of an office building to a residential one (making it ‘permitted development’). Drawing on original empirical research in five local authority areas in England, this article examines the impacts of this deregulation of planning control on the ground. We find that, although more housing units have been delivered than were expected, a focus on housing numbers is eclipsing problems of housing quality, the type of housing being made available and whether it is in sustainable locations. There are also costs of deregulating planning, including direct financial costs and the lost opportunity to secure affordable housing and public infrastructure through planning gain. We conclude by examining the contradictions in the UK government’s approach to addressing the housing crisis and propose there are dangers of deregulating the urban that have consequences for England and other countries pursuing neoliberal reforms.

The relationship between alcohol-related hospital admission and specialist alcohol treatment provision across local authorities in England since passage of the Health and Social Care Act 2012.

To our knowledge no previous studies have been conducted at the local authority level assessing relationships between alcohol-related hospital admission, specialist alcohol treatment provision and socioeconomic deprivation since the UK government passed the Health and Social Care Act in 2012. Our results, using publicly available national data-sets, suggest that the local authority areas in England most in need of adequately funded specialist alcohol treatment, because of high prevalence of alcohol dependence and deprivation, are not receiving targeted increased funding, and that the national rise in alcohol-related hospital admissions may be fuelled by local authority funding cuts to specialist alcohol treatment.

Delivery of community-centred public mental health interventions in diverse areas in England: a mapping study protocol.

BackgroundPublic mental health (PMH) is a global challenge and a UK priority area for action. However, to progress, practitioners require a stronger evidence base regarding the effectiveness of approaches, particularly regarding promotion and prevention through community-centred interventions. In addition, policy-makers need to understand what is being delivered, particularly in areas of high need, to identify promising practices or gaps in PMH provision. Finally, and importantly, the public need better information regarding what approaches and services are available to them. We report a protocol designed to (1) identify the types of community-centred interventions used in purposively selected diverse geographical areas of England to improve PMH outcomes and (2) describe the type, target population, content and outcome measures of each intervention.Methods and analysisFive local authority areas of England were selected based on either high social deprivation or differing ethnic population statistics and geographical locations. Community-centred interventions in each area will be identified through: (1) desk-based data capture from standardised searches of publicly-available information (eg, policy, strategy and intervention advertising), (2) established professional networks and service contacts, (3) chain-referral sampling of individuals involved in local mental health promotion and prevention and (4) peer researchers, who will use their personal experience and local knowledge to help identify potentially relevant organisations. Data on the key features of the interventions will be extracted from individuals either by structured interviews or by electronic questionnaires with information regarding the intervention(s) of which they have knowledge. Initial data analysis will involve tabulating descriptive information and grouping interventions according to intervention type, target population, risk/protective factor and intended primary outcome. A descriptive comparison will be made between selected geographical areas.Ethics and disseminationEthical approval was obtained from Durham University’s Department of Sport and Exercise Sciences Research Ethics Committee. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals. We also plan to disseminate to the public and intervention providers through social media and/or newsletters.

Increasing evenness in the neighbourhood distribution of income poverty in England 2005–2014: Age differences and the influence of private rented housing

A recent change in the geography of poverty in Britain has been reported: it appears to be becoming more evenly distributed in major cities, such that low-income individuals are less likely to be living in the highest poverty areas. Studying all local authority areas in England between 2005 and 2014, this paper finds that this phenomenon is strongly differentiated by age group and local authority type. Poverty amongst children and working age people is becoming more evenly distributed in almost all local authority types, with the largest changes occurring in the most urban areas. The change is strongly associated with the increasing proportion of low-income households living in private sector housing. Conversely, there is evidence of an increasing residential concentration of poverty at older ages. The paper also proposes a method for decomposing a change in rates between changes in the numerator and changes in the denominator. It concludes by discussing the implications of these findings for area effects, area-based initiatives and gentrification by displacement.

Towards an inclusive understanding of bullying: identifying conceptions and practice in the primary school workforce

Bullying is defined in a variety of ways in different contexts, and each individual school in England is required to develop its own working definition, parameters and policy. This paper explores a variety of definitions from government and third sector organisations in the UK, making comparison with those from other contexts. In particular, it considers whether bullying is repeated behaviour or experience, and how labels such as target, victim and perpetrator have the potential to damage individual identities. It highlights common themes and differences across definitions and interpretations, comparing them with those of staff (n =131) drawn from research in 16 schools in one large local authority area in England, detailing their conceptions and experiences of bullying. These staff identify whether, where and how bullying is encountered in their settings, how they address such issues, and whether there are particular stimuli on which they focus. It concludes that a redeveloped, clear and understandable definition of bullying is needed that is accessible to all stakeholders in schools, including children. This needs to be inclusive in its focus, unambiguous and applicable across a broad range of settings, leaving aside the historical baggage associated with the subject.

“We’re not a bottomless pit”: food banks’ capacity to sustainably meet increasing demand

Based on research with 21 food banks across eight local authority areas in England, this article examines the sustainability of food banks in their attempts to balance demand and supply. Against a background of multiple deprivation and welfare reforms in the UK, food banks are becoming increasingly important for growing numbers of people. However, at a time when food banks’ ability to meet this increasing demand is close to capacity, this article examines how social purpose is a core element in food banks’ understanding of sustainability. With food banks having little control over the level of demand, and supply being increasingly close to capacity, if demand exceeds supply, sustainability will necessitate either denying demand or expanding supply.

To bridge the gap? Voluntary action in primary schools

Voluntary action has long played a role in state education, with parent–teacher associations being one of the most common forms of charitable organisation in England. However, education policy, driven by a growing free-market discourse and policy initiatives such as localism, is increasingly pushing for greater voluntary action. This article explores the distribution of voluntary action in primary schools in one local authority area in England. Drawing on primary data from 114 questionnaires completed by head teachers and secondary data from the financial records (2013/14) of 380 primary schools, we find evidence of considerable uneven dispersal of voluntary action between schools. These disparities are related to factors including school size, location, leadership ideology and the socioeconomic profile of the school. The consequence of this uneven distribution is that schools catering for more affluent communities are more likely to have additional resources than those with poorer profiles.

Listening for commissioning: A participatory study exploring young people's experiences, views and preferences of school-based sexual health and school nursing.

To explore the experiences, views and preferences of young people aged 11-19years regarding school-based sexual health and school nursing to inform commissioning and delivery for one local authority area in England during 2015. Promoting sexual health for young people remains a challenging, even controversial, but important public health issue. Concerns regarding accessibility, acceptability and efficacy in school-based sexual health and school nursing are evident in the literature. Additionally, a complex public health policy context now governs the funding, provision and delivery of sexual health and school nursing, which potentially presents further challenges. A qualitative, participatory design was used to explore sexual health and school nursing. Data were generated from 15 focus groups (n=74), with young people aged 11-19years, in educational-based settings in one local authority area in England. The resultant themes of visibility in relation to sexual health education and school nursing revealed both the complex tensions in designing and delivering acceptable and appropriate sexual health services for young people and the significance of participatory approaches. Our study shows the importance of participatory approaches in working with young people to clearly identify what they want and need in relation to sexual health. The findings also confirm the ways in which school-based sexual health remains challenging but requires a theoretical and conceptual shift. This we argue must be underpinned by participatory approaches. School nurses have always had a significant role to play in promoting positive sexual health for young people and they are exceptionally well placed to challenge the risk-based cultures that frequently dominate school-based sexual health. A shift of debates and practices towards the promotion of positive sexual health cultures though previously argued for now requires the active engagement and involvement of young people.

Doing, Being and Becoming a Valued Care Worker: User and Family Carer Views

ABSTRACTThis paper presents and discusses data from a study of the views of people using social care services and of family carers about their care workers, what they do that is valued, what are valued characteristics, and how people become or are made ‘good’ care workers. It is set within the context of policy interest in England in values based recruitment as a means to address some of the problems in social care services arising from high levels of turnover and variable care quality. Such efforts to promote values-based recruitment have brought the question of values centre stage in social care in addition to their more established place in social work and other professions. The interviews with services users and carers (n = 60) were conducted face to face in four local authority areas in England. Findings are that service users and carers value staff’s presentation and performance; relationships with care workers; but hold different conceptualisations of training as adding to their workers’ capability and approach. Values appear to be viewed as innate to individuals and not fostered by training. These suggest some differences between values that are integral to professional identities and those that are deemed important in care work.

Being self in later life: maintaining continuity in the face of change

Purpose – The purpose of this paper is to build upon existing knowledge of personalisation through an improved understanding of how the use of personalised social care services can support older people’s sense of self. It contains perspectives that are helpful to the development of personalisation policy and practice and to the future commissioning of social care services. Design/methodology/approach – The research involved a qualitative study with eight participants in two local authority areas in England. A series of three in-depth interviews conducted with each participant over a four to six week period explored their experience of using (in one case refusing) a direct payment to meet their social care needs. Ethical approval was obtained prior to the start of fieldwork via the research ethics committee of the author’s home university. Findings – Two inter-related themes emerge as findings of the research. First, that the locus of personalisation resides within the interpersonal dynamics of helping relationships; participants experienced personalisation when carers helped to meet needs in ways that validated their narrative of self. Second, whilst the experience of personalisation is not strongly related to consumer choice, it is important that older people are able to exercise control over and within helping relationships. Research limitations/implications – This is a small scale qualitative study conducted with only eight participants. Whilst it offers valid insights into what constitutes personalisation and the processes by which it was achieved for the participants, caution is required in applying the findings more generally. With the exception of one case, the study is focused exclusively on first person accounts of older people. Future studies might usefully be designed to incorporate the accounts of other involved parties such as family members and paid carers. Originality/value – The paper provides an alternative way of approaching personalisation of social care services for older people by exploring it in terms of its impact on self. It identifies the development of accommodations of “special requirements of Self” in helping relationships as a key mechanism of personalisation. This offers a balance to the current focus on consumer choice and control through the development of market like mechanisms.

Estimating the measurable impact of local alcohol licensing policies on population health in England using ecological longitudinal data

BackgroundAlcohol policy in England is determined at local government level, and as a result differences between local authorities in priorities around how best to reduce the effects of alcohol consumption have led to variability in local composition of alcohol control policies and interventions. An important policy area is that of regulating the physical availability of alcohol and modifying the commercial drinking environment. We evaluated whether the intensity with which local licensing policies, including specifically cumulative impact zones, were implemented and enforced has resulted in measurable differences in local population health. MethodsAlcohol and late night refreshment licensing data (2007–12) from the Home Office were linked to alcohol-related hospital admissions from the Local Alcohol Profiles for England, and to population size and area deprivation at local area level. Cumulative policy and enforcement intensity was coded as passive, medium, or high on the basis of presence of cumulative impact zones, whether any new licence applications were successfully challenged, or both. Changes in directly age-standardised rates of people admitted to hospital with alcohol-related conditions in 2009 to quarter one of 2015 were analysed with mixed-effects log-rate models adjusted for seasonality, population size, deprivation, and alcohol-related crime rate. FindingsData were obtained for all 326 lower tier local authority areas in England, of which 319 provided licensing activity data. Spatial autocorrelation in licensing policy intensity was negligible (Moran's I=0·02). An exposure-response association was observed, with an additional average decrease in alcohol-related hospital admission rates in the areas with the highest intensity policies compared with passive areas of 2% annually (95% CI −3 to −2, p=0·006). Accounting for other population changes, this equated to a modest additional 5% reduction, or about eight unique admissions per 100 000 people, in 2015 compared with what would have been expected had these areas not had active policies in place. InterpretationAlthough these analyses do not directly prove causality, they add to the available evidence about the efficacy of alcohol licensing policies specifically for England. Despite the fairly modest average effect, the intensity of alcohol licensing policies implementation and enforcement is related to measurable health gain. FundingThis work was funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR).

Models for Combining Aggregate-Level Administrative Data in the Absence of a Traditional Census

Abstract Administrative data sources are an important component of population data collection and they have been used in census data production in the Nordic countries since the 1960s. A large amount of information about the population is already collected in administrative data sources by governments. However, there are some challenges to using administrative data sources to estimate population counts by age, sex, and geographical area as well as population characteristics. The main limitation with the administrative data sources is that they only collect information from a subset of the population about specific events, and this may result in either undercoverage or overcoverage of the population. Another issue with the administrative data sources is that the information may not have the same quality for all population groups. This research aims to correct an inaccurate administrative data source by combining aggregate-level administrative data with more accurate marginal distributions or two-way marginal information from an auxiliary data source and produce accurate population estimates in the absence of a traditional census. The methodology developed is applied to estimate population counts by age, sex, and local authority area in England and Wales. The administrative data source used is the Patient Register which suffers from overcoverage, particularly for people between the ages of 20 and 50.

Older People, Personalisation and Self: an alternative to the consumerist paradigm in social care

ABSTRACTPersonalisation of social care for adults is a key policy objective in the United Kingdom (UK), as in many other welfare states, having gained wide acceptance as essential for the empowerment of service users and as a means of managing increasing population demand. The system of personal budgets being established in the UK pursues twin objectives: aiming to ‘empower’ individuals to achieve ‘more for less’. However, there is mixed evidence that either objective is being achieved in practice. This is especially so in respect of older people who are less likely to accept a personal budget and more likely to be dissatisfied with their experience of using one. A qualitative study of eight cases in two local authority areas in England explored older people's experience of using a personal budget taken in the form of a direct payment. Data were elicited through a series of three in-depth interviews with each participant. The study was concerned with understanding the relationship between participants' experience of ‘Self’ and personalised services. Participants experienced personalisation when paid carers perceived and accommodated their ‘special requirements of Self’. In most cases this was achieved despite the consumerist aspects of personalisation rather than because of them, and often gave rise to risk and dilemma. The findings emphasise the importance of holistic assessment, and commissioning for quality over maximising choice.

Factors that predict dissemination of evidence-based practice in one local authority in England: An assessment of introducing node-link mapping into substance misuse practice

Aims: Node-link mapping (NLM) has been strongly advocated as a cognitive tool that aims to enhance the treatment process and is supported by a large evidence-base. In one local authority area in England, NLM was systematically introduced and embedded into staff daily practice across five main services including non-statutory, NHS and young people’s services. The study aimed to assess training and adoption of NLM prior to implementation into daily practice. Methods/Results: In total, 123 staff members were trained in NLM concepts across a number of workshops. Staff responses were recorded in a Workshop Evaluation Survey that suggested a high degree of satisfaction with the training provided although “time” was identified as a pre-requisite to prepare for implementation. A random sample of staff (n = 44) were followed-up at 6 months and were asked to complete a Workshop Assessment Follow-up schedule alongside participation in focus group interviews. Despite a commitment to NLM, there were mixed perceptions into the efficacy of node-link mapping. Staff concerns focused on lack of perceived ownership of the implementation process and a lack of confidence in using mapping on a regular basis. Managers also reflected reservations with “traditional” training methods and how to incorporate new practices into supervision processes. Implications for the dissemination of evidence-base practices are discussed.

The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study

Objective To investigate whether the policy of increasing National Health Service funding to a greater extent in deprived areas in England compared with more affluent areas led to a reduction...