National Policy Drivers Research Articles

Policies and Strategies for Revitalizing America’s Manufacturing Communities

After decades of decline and political indifference, U.S. manufacturing is getting fresh attention, in national elections and in research about economic disparities between communities and America’s technological leadership. For the past two years, the authors of this report have worked on two-year project, sponsored by The Century Foundation (TCF) and its Bernard L. Schwartz Rediscovering Government Initiative (RGI), to elaborate on the contours of a policy that will not only revitalize the manufacturing industry, but lift the fortunes of struggling communities (urban, rural, and suburban) that have long looked to manufacturing as a source of good paying jobs and economic growth. The two-year project included three major research reports and interactions with nearly 500 stakeholders at community events throughout the industrial Midwest. The paper summarizes the research and (i) discusses why manufacturing remains important, (ii) presents a comprehensive framework for regional industrial policies best practices, and (iii) suggests the key state and federal policies and actions needed to revitalize manufacturing communities. The comprehensive framework identifies two major national policy drivers (trade and government purchasing) and four regional drivers (innovation, industrial retention, workforce and capital) that are all needed for U.S. manufacturing to recapture its economic promise.

Is there a Prosumer Pathway? Exploring household solar energy development in Germany, Norway, and the United Kingdom

Prosuming – where private households use photovoltaics to produce electricity at home – has proliferated across Western countries, but growth rates have varied significantly. Focusing on Germany, Norway and the United Kingdom, this article explores the major factors that influence national prosumer figures between 1990 and 2017, and whether a development pathway can be identified. Support schemes, direct regulatory provisions, information and third-party installer markets are analysed through document studies, controlling for domestic context. This study confirms that changes in support schemes have been influential for the development of prosuming in all three countries; access to information and the presence of a third-party market have also been important. There are indications of differences elsewhere in the domestic context. For Germany and the UK, decarbonization has been a significant driving force for policy, unlike in Norway, where a boost in prosuming is now underway. While all three countries show similar early interactions between market and regulatory provisions, different national policy drivers indicate that different national prosumer pathways are possible.

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

ObjectivesThe role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or...

The use of telemedicine to enhance secondary care: some lessons from the front line

Digital technologies such as telemedicine have the potential to transform healthcare, but uptake has only recently gained momentum secondary to national policy drivers. This paper reviews the potential benefits of telemedicine in secondary care and explores the use of video conferencing to support the hospital follow-up of older people with chronic disease, identifying a wide variety of issues that need to be addressed for successful implementation. We believe these issues will interest secondary care colleagues considering the use of telemedicine to support or substitute for some outpatient activities.

Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site.

There are national policy drivers for mental health services to demonstrate that they are effectively meeting the psychological needs of people with long-term health conditions/medically unexplained symptoms (LTC/MUS). To evaluate the implementation of a stepped-care service delivery model within an Improving Access to Psychological Therapies (IAPT) service for patients with depression or anxiety in the context of their LTC/MUS. A stepped-care model was designed and implemented. Clinical and organizational impacts were evaluated via analyses of LTC/MUS patient profiles, throughputs and outcomes. The IAPT service treated N = 844 LTC and N = 172 MUS patients, with the majority (81.81%) receiving a low intensity intervention. Dropout across the service steps was low. There were few differences between LTC and MUS outcome rates regardless of step of service, but outcomes were suppressed when compared to generic IAPT patients. The potential contribution of IAPT stepped-care service delivery models in meeting the psychological needs of LTC/MUS patients is debated.

Developing a perinatal mental health module: An integrated care approach

Midwives have a key role in identifying women at risk of perinatal mental health problems, referring to specialist services, planning care where appropriate, and supporting women and their families. Current guidelines and standards do not place an emphasis on perinatal mental health care as central to the training of student midwives in the UK. Research has shown that midwifery students and midwives do not feel skilled in this aspect of their role. At the University of Surrey, a programme-specific perinatal mental health module was developed for student midwives in the second year of their pre-registration programme, which has been well evaluated. Service users and specialist mental health practitioners have been involved in developing and teaching the module, and the content is reviewed annually to reflect national policy drivers.

Planning and best practice guidance: A route map to help householders with their energy saving retrofits

This paper presents the experience of delivering a local authority led, solid wall insulation focused energy efficiency scheme. The aims are to present the national and localised policy context in which the scheme was developed, and to identify the major challenges that have arisen during the delivery phase of the scheme. Four key themes are identified: planning consents and traditional construction; customer engagement and knowledge; industry transition; and national policy drivers. The examination of these key areas of challenge focuses on the issues for delivery at scale within the private owner-occupier sector. The following section considers Bristol City Council's solutions to improving customer experience and the industry's ability to improve its understanding of building physics to drive improvements in the quality of installations. The paper concludes by drawing together the challenges and solutions: making suggestions of improvements for energy literacy for customer engagement and empowerment; developing installer training and a kitemark, or industry standard, to drive quality in the industry; as well as suggestions on how a more holistic approach to energy retrofitting could deliver the former and see real savings for energy and CO2.

A Study of How Health Visitors Exchange Knowledge in the Context of Organisational and Policy Change

This paper draws upon selected findings from a small scale qualitative study of the situated practice of health visitors. The study was carried out in a context of local organisational change, after the merger of two primary care trusts in the north of England, and emergence of national policy drivers positioning health visitors in a leadership role in the delivery of integrated services to children and families. The findings from four focus groups give grounded and context specific examples of the types of knowledge that health visitors value and ways in which they exchange knowledge and draw upon the distributed knowledge and expertise of others. The results are interpreted through the lenses of different discourses of knowledge and barriers to change are identified through an iteration between practice-based narrative and theoretical frameworks. These barriers include: dominance of linear and hierarchical transmission models of knowledge transfer rather than promotion of a knowledge sharing/creating culture; a devaluing of context specific and practice based knowledge in comparison to abstract knowledge; bureaucratisation of knowledge; defensive practices emerging from a perceived threat to professional identity; and limited tools and allocation of time for collaborative work within the profession and across professional boundaries. Recommendations and strategies to drive change and enable health visitors to take on leadership roles in multi skilled teams and a multi agency context are underpinned by the argument that what is needed in this context is a transformational model of knowledge exchange and co creation of knowledge that works with tensions between different discourses of knowledge and promotes collaborative dialogue and practice across professional and organisational boundaries.

Priority questions to shape the marine and coastal policy research agenda in the United Kingdom

United Kingdom (UK) and European Union policy is rapidly developing to meet international targets for the sustainable use and protection of the marine environment. To inform this process, research needs to keep pace with these changes and research questions must be focused on providing robust scientific evidence. Thirty four priority research questions within six broad themes were identified by delegates who attended the 1st marine and coastal policy Forum, hosted by the Centre for Marine and Coastal Policy Research at Plymouth University in June 2011. The priority questions formed through this research are timely and reflect the pace and change of marine policy in the UK in response to international, European and national policy drivers. Within the data theme, the majority of questions seek to find improved procedures to manage and use data effectively. Questions related to governance focus on how existing policies should be implemented. The marine conservation questions focus entirely upon implementation and monitoring of existing policy. Questions related to ecosystem services focus on research to support the conceptual links between ecosystem services, ecosystem function, and marine management. Questions relating to marine citizenship are fundamental questions about the nature of societal engagement with the sea. Finally, the marine planning questions focus upon understanding the general approaches to be taken to marine planning rather than its detailed implementation. The questions that have emerged from this process vary in scale, approach and focus. They identify the interdisciplinary science that is currently needed to enable the UK to work towards delivering its European and international commitments to achieve the sustainable use and protection of the marine environment.

‘Closing the gap’ – A partnership approach to community care education for long term conditions

The aim of the project/evaluation was to establish a Community of Practice (CoP) with the purpose of enhancing the skills of the workforce and developing learning resources to improve service delivery for people with long-term conditions. International and national policy drivers espousing new community-based inter-agency models of delivery have led to rapid transformation of services for people with long-term conditions. Many in the workforce lack the skills required to respond to the increased acuity of patients or function within a fully integrated, inter-agency service. A partnership involving a community provider, a commissioner and a University initiated a 'CoP' project with the aim of promoting knowledge-exchange between academic and practice staff. The CoP was the vehicle for addressing gaps in knowledge and skills of the academic and practice workforce. An evaluation of the CoP was conducted after 1 year. The evaluation sought to explore how the CoP shaped the project's impact, the resultant changes in clinical practice and how involvement influenced participants' knowledge of new models/approaches. The CoP was made up of 34 academic and practice staff and was a forum for building collective knowledge that would shape practice. Qualitative data collection involved a focus group, questionnaire survey and notes of the CoP meetings. Participants became more conversant with integrated models of care and identified and addressed gaps in knowledge and skills including real world complexity to reduce escalation of care. Participants found a well-facilitated CoP to be a supportive and effective vehicle for helping a workforce change process. A well-organised Community of Practice, delivered as an inter-agency partnership, was found to be very effective in contributing to a better-prepared workforce. With targeted investment a facilitated CoP appears to be a useful vehicle for addressing workforce needs in complex and challenging circumstances.

Redesigning a local authority residential care home to provide an intermediate care resource

Key national policy drivers have identified the need for change in the way that services are delivered, with shifts to interagency redesign and the need for a whole system approach to early intervention, prevention, rehabilitation and enabling. A redesign of a wing of a Scottish Borders local authority residential care home to provide an intermediate care resource was carried out in 2008–09 and fully evaluated. This paper presents the main findings of the evaluation and concludes that the redesign has demonstrated an effective model that can be a transferable framework to deliver intermediate care in other residential care homes.

Overview of the NIMHE/CSIP National Dual Diagnosis Programme in England

This paper reviews the work of the national dual diagnosis programme established in England in response to recommendations for improvements in the way that services treat people with mental health problems and substance misuse issues. National policy drivers are explained, as well as the aims and achievements of the programme to date.

The art of auscultation: evaluating a patient’s respiratory pathology

This article considers national policy drivers promoting the development of advanced assessment skills and practical procedures for the safe and effective use of the stethoscope in the clinical area. The evidence base underpinning effective use of the stethoscope in clinical practice is explored, including the preparation of the patient and the environment, applying infection control policies, and placing an emphasis on privacy and dignity. This is followed by a practical guide to auscultation technique of the respiratory system for nurses developing advanced practice skills.

Specialist nurses for older people: implications from UK development sites

This paper is a report of a study to explore the development of specialist staffing for older people in six case study sites in the United Kingdom. In the United Kingdom there has been some concern about the health care available to older people, leading to the development of a National Service Framework. A key theme of this framework is the development of specialist staff skilled in providing services tailored to the needs of older people. A soft systems methodology was used in 2004-2005 to carry out interviews with key people, including specialist nurses for older people, other service providers, patients and informal carers (n = 132) in six case study sites identified from a national questionnaire. Interviewees were asked to describe their perceptions of the development, its history and its impact. The development of specialist nursing services seemed to be shaped by national policy drivers for service development, which may not have been directly linked to the needs of older people. The ideal qualities of a specialist nurse for older people were described by participants as including not only knowledge and skills, but also personal characteristics. While progress has been made in establishing specialist posts, much remains to be explored about the roles of postholders, the qualities needed, and the support and preparation required. While advanced practice is a professional aspiration, a number of questions arise about the development of nursing as a self-directing profession in diverse international settings. Theories of specialist nursing practice also need to address the tensions between universal and local models and to consider theories about nursing older people.

Housing Stock Transfer in Birmingham and Glasgow: The Contrasting Experiences of Two UK Cities

ABSTRACT Housing stock transfer is arguably one of the more controversial aspects of New Labour's housing policy. It was a policy originally pursued under the Conservative governments from the 1980s into the early 1990s and has gained pace under New Labour since 1997. Across Britain, the Westminster government, along with the devolved Scottish and Welsh administrations in Edinburgh and Cardiff, have all demonstrated a commitment of late to the use of stock transfer to reshape and reconfigure social housing provision. This paper considers some of the key aspects of stock transfer, not least the underlying national policy drivers of demunicipalization and use of private finance, and then explores the contrasting fortunes of stock transfer in the two largest local authority social housing authorities in Britain, that is Birmingham and Glasgow. In 2002 Birmingham tenants rejected stock transfer while in Glasgow, following a tenant vote for transfer, the city's entire council housing stock was transferred to a...