Specialist Staff Research Articles

Scaling up integrated care: Can community hospitals be an answer? A multiple-case study from the Emilia-Romagna region in Italy

Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.

Developing new methods for patient care pathway assessment for breast cancer patients in Hungary

Abstract Issue The idea of progressive healthcare models is to treat patients preferably in one location as close to their homes as possible. This contradicts the demands of efficiency: to centralise the availability of expensive procedures and highly specialised staff. Healthcare systems need to navigate between these challenges, especially in public health issues such as cancer care. Description of the problem Achieving the best possible health outcomes requires evidence-based policies that find balance between the demands of accessibility and efficiency. Therefore, we aimed to set up a methodology to review the healthcare model and assess patient movements across the system. We analysed the roaming paths of breast cancer patients diagnosed in Hungary in 2017. Inter-hospital roaming was represented as a graph: hospitals were the nodes, patient movements from one hospital to another were directed edges. This allowed us to apply network analysis: modularisation, weighted degrees calculation, etc. We then introduced the measure of terminality. A hospital is terminal in a given pathway if it is the last new one, i.e. all hospitals visited later had already been visited before. Terminality is defined as the proportion of terminal events among all pathways that cross a given hospital. The rationale of this is that the last hospital in cancer pathways is usually not the highest level one: after advanced treatments, patients are often referred back to local hospitals. Results Testing the method on Hungarian breast cancer patients we observed that results fit our prior expectations. The official ranking of hospitals on the progressivity scale (reflecting the availability of advanced treatments) shows sufficient agreement with terminality. Minor differences may point to situations where the healthcare system does not work fully according to regulations. Lessons Our methodology is recommended for system level patient pathway analysis in order to develop evidence-based healthcare policies. Key messages • Graph representation of inter-hospital patient roaming supports evidence-based policy developments for more efficient patient pathways in cancer care, regardless of the healthcare system design. • The applied new network analysis methodology can help assessing the real life processes of cancer care in a healthcare system through identifying the specifics of inter-hospital patient movements.

Educational management in personnel training of hydrometeorological services: world experience

Introduction. The relevance of the presented study is determined by the fact that the acceleration of climate change on the planet has a significant impact on almost all spheres of economic and social life of mankind, which imposes new requirements both on the information provided by hydrometeorological services and on the personnel of managers and specialists providing it.Purpose setting. The purpose of the presented studies is to summarize the world experience in the development of promising requirements for the skills and competence of managers and specialists of national meteorological services in the interests of forming a system of requirements for staffing and training of managers and specialists of hydrometeorological services of the Roshydromet system.Methodology and methods of the study. The methodological base of the research consists of well-known scientific works devoted to the promising requirements for the skills and competencies of managers and specialists of the hydrometeorological service. Results. The novelty of the obtained results lies in the fact that, based on the generalization of world experience in the development of promising requirements for the skills and competence of managers and specialists of national hydrometeorological services, it was found that when forming personnel management strategies, on the one hand, requirements are put forward for a wide range of competencies of personnel who own both traditional technologies and innovative technologies for processing and interpreting information based on IT. On the other hand, hydrometeorological services impose increased demands on themselves, which is manifested in strategic aspirations to form a holistic motivation system for their employees, covering all levels of human needs, according to substantive theories of motivation – from economic competitiveness to opportunities for training, development and self-expression.Conclusion. The practical significance of the obtained results lies in the possibility of using world experience in developing promising requirements for the skills and competence of managers and specialists of national meteorological services when forming strategies for personnel management of hydrometeorological structures of the Roshydromet system.

‘It's something that people don't have the knowledge of’: Perceived participation of pupils with Prader‐Willi syndrome in specialist schools and staff preparedness

AbstractThere is an abundance of literature on health‐related outcomes for children and young people with Prader‐Willi syndrome and on their lived experiences as well as on their caregivers'. However, little is known about the experiences of education practitioners when providing for them. This study gathered in‐depth evidence of the lived experience of school staff in two secondary specialist schools, on (1) perceptions of functioning and participation of young people with Prader‐Willi syndrome in the setting and (2) how prepared they felt to support them in achieving full participation, including challenges faced. Semi‐structured interviews were conducted with six school staff and transcripts were analysed both deductively (using the ICF classification system) and inductively. School staff perceive the needs of these pupils as mostly related to their body functions, in alignment with a medicalised understanding of disability. However, they recognise the key role of environmental modifications to address these. Staff feel mostly unprepared and perceive their training as limited. Despite wide recognition of the need to conceive disability holistically, medicalised understandings are still present. Training from a biopsychosocial perspective is needed. Future research should address the development of core sets of ICF codes for people with Prader‐Willi syndrome.

The Degree to Which Public School Principals Possess Artificial Intelligence Applications in the Karbala Governorate Education Directorate

The study aims to identify the degree of possession of government school principals in the Karbala Governorate Education Directorate of artificial intelligence applications. The descriptive analytical approach was used. To achieve the study objectives, a questionnaire which contained (34) items was developed, divided into five dimensions. The study community was (114) male and female principals. The study sample consisted of (94) male and female managers, and the sample was selected randomly. The results of the study showed that the degree of possession of government school principals in the Karbala Governorate Education Directorate of artificial intelligence applications was average. The results of the study also showed that there were no statistically significant differences at the significance level (α=0.05) attributed to the study variables (gender, academic qualification, experience in artificial intelligence techniques). In light of the study results, the researchers recommended several recommendations, most notably: paying attention to training courses in the field of information and communications technology, especially in the subject of artificial intelligence, by organizing meetings and workshops with the aim of raising awareness among individuals and society about the importance of artificial intelligence, encouraging the Iraqi Ministry of Education to its teaching staff and providing them with incentives to employ artificial intelligence applications in their administrative and educational work, introducing artificial intelligence applications into curricula and courses and paying attention to them, and providing specialized teaching staff in this field.

Structural Requirements for the Outpatient Treatment of Benign Diseases of the Uterus.

In many cases, outpatient surgical treatment of benign diseases of the uterus has advantages over inpatient care. This has been demonstrated by the healthcare situation in other countries. However, the prerequisite for the provision of outpatient services is that this does not lead to any impairment in the quality of care or of patient safety. The ultimate goal should not be to reduce costs but rather to maintain and, ideally, improve the quality of care. This requires that services are not just defined by the surgical procedure but also by the entire treatment chain, including, for example, psychosocial support, and are remunerated accordingly. It is particularly worrying that the final decision as to whether an outpatient operation is possible is not the responsibility of the operating unit, but of the "Medizinischer Dienst," with the corresponding options and threats of sanctions. This situation is unique internationally and requires a paradigm shift. Furthermore, structural prerequisites must be maintained which currently only exist inadequately in Germany. Since a substantial proportion of planned outpatient operations require immediate or secondary inpatient treatment, there must be a barrier-free transition between the outpatient and inpatient sectors. This will require the creation of networks between outpatient service providers and one or more hospitals that are equipped and competent to manage even complex complications. It is important to create structures that, with intensive involvement of the operating unit, include adequate preoperative evaluation and patient education as well as needs-oriented postoperative care at home. The current separation of sectors is a significant hinderance. Moreover, when expanding and promoting outpatient surgery, the aspect of training and further education of specialist staff must be taken into account, as well as cross-sectoral quality assurance. Based on a review of the international literature, this article presents 13 recommendations for adequate structures when providing outpatient services which should serve as a prerequisite for the greatest possible guarantee of patient safety.

The maturity indicators of legalcompetence of the ship’scommand staff specialist at the higher maritime educational institution

The article depicts the indicators of reaching the maturity of legal competence during the training of military students at the maritime higher educational institution. The criteria of maturity of professional legal competence are defined for the would-be ship’s command staff specialists.

직무스트레스와 직무만족의 영향에서 상사관계 및 동료관계의 조절효과: 서울시교육청 교육행정직과 교육전문직 비교

This study examined the effects of job stress on job satisfaction among public officials in the Office of Education. Specifically, the study explored how the effects of job stress on job satisfaction differ depending on leader and colleague exchanges in these relationships. For this purpose, data from 474 officials from the Seoul Metropolitan Office of Education were collected and analyzed. A hierarchical multiple regression analysis was used to identify the moderating effect, and a simple slope analysis was conducted to examine the differences between high and low groups for each job category. The dependent variable was the job satisfaction of education office officials, the independent variable was job stress, and the moderating effects were leader and colleagues exchanges. As a result of the multiple regression analysis, it was found that the higher the job stress of the Office of Education officials, the lower the job satisfaction level. Furthermore, there were interaction effects between the leader and colleague exchanges. On the other hand, there was a difference in the moderating effects of leader and colleague exchanges between the higher and lower groups(total group 10%, educational administration group 8%, education professional group 26%). There was also a difference in the moderating effects of colleague exchanges between the high and low groups(total group 12%, educational administration group 12%, education professional group 32%). The results of this study suggest that social support from leaders and colleagues is important for improving the job satisfaction of public officials in the Department of Education. In particular, it highlights the need for organizational management that reflects the specific characteristics of different job groups, such as education administrative staff and education specialists.

Exploring challenges and innovation in memory assessment services in England and Wales – a national survey and case study approach

BackgroundTo explore the design, delivery models and identify good and innovative practices in Memory Assessment Services (MAS) in England and Wales.MethodsA two-stage service evaluation comprising (1) on-line survey of MAS providers to identify features of the commissioning models, service design, delivery, and challenges alongside examples of good/innovative practice; (2) qualitative case studies using video/telephone interviews with key staff and people who had used the service.ResultsThe 49 respondents to the survey reported a shift in delivery of MAS post COVID and identified key areas for improvement, including a need for specialist staff, support for MCI and rarer dementias, and capacity for post diagnostic support. The 15 case studies illustrated good practice and innovation focusing on post diagnostic support, equity of access, working with external services/service location, MCI and rarer dementia and involving specialist staff.ConclusionsThe evaluation speaks to the importance of (re)evaluation of services to identify local need and the importance of commissioning based on local need and innovative approaches that my sit outside of ‘typical’ MAS pathways.

Time to start disease modifying drugs for adults with seropositive rheumatoid arthritis: results of the first year of the national New Zealand Rheumatology Association (NZRA) audit.

This audit describes variation in the time from referral to starting disease modifying drug (DMARD) for people with newly diagnosed seropositive rheumatoid arthritis (RA), how frequently this was within the recommended 6 weeks and whether regional, service-level or patient-level factors were associated with this variation. Rheumatologists submitted data on new patients with a new diagnosis of rheumatoid factor and/or cyclic-citrullinated peptide antibody positive RA. The association between visit funding, ethnicity, socio-economic deprivation, rurality, local specialist staffing levels and the time to DMARD treatment was assessed using Cox proportional-hazard models. Data were collected on 355 patients over 12 months. Overall, 64.8% of patients commenced DMARD treatment within 6 weeks of referral and this was associated with rheumatologist FTE per 100,000 population (adjusted HR 2.47, 95%CI 1.27-4.81; p=0.008) and the rurality (Geographic Classification of Health [GCH]) of the patient (for R2 compared to U1 adjusted HR 0.20, 95%CI 0.09-0.43; p<0.001). There was no association between time to DMARD and ethnicity or socio-economic deprivation. There was significant variation in time to DMARD treatment, mainly related to variation in rheumatologist staffing levels and patient rurality. Rheumatologist staffing levels of 1.0 FTE/100,000 population was associated with 80% of patients meeting the recommended 6-week time to DMARD treatment.

Content analysis of current role/job descriptors for Band 5/junior physiotherapists and mapping of these to Physiotherapy Professional standards of practice

BackgroundKNOWBEST was a mixed methods study exploring the KNOWledge, BEhaviours and Skills required of the modern physioTherapy graduate. ObjectivesTo undertake a content analysis of current role descriptors (RDs) for Band5/junior physiotherapists and map these to the knowledge, skills, behaviours and attributes required for contemporary physiotherapy practice. DesignContent analyses and mapping. SettingAll health care settings: ParticipantsAvailable RDs for newly qualified/Band 5 physiotherapists across a representative range of roles and settings for this stage of a physiotherapist’s career across the UK and all health care settings. MethodsJob descriptors were obtained using three approaches 1) via direct upload to the study website, 2) on-line searches of job vacancies, 3) directly emailing managers to fill any gaps in representativeness. Data regarding knowledge, skills, behaviours and attributes were extracted, coded (BC) and checked (CML). Data analysesDocumentary content analyses and mapping of these to Professional Standards of practice. Results19 RDs were analysed. High expectations of behaviours and attributes, and extensive pre-requisite knowledge and skills were identified and detailed. Considerable variability was seen across RDs, at least seven being suited to more highly specialist and/or experienced staff. Equality, diversity and inclusivity concerns were evidenced. Active research was not included in many RDs and not mentioned in any standards. Digital learning and skills were not strongly evidenced. ConclusionsA review of Band 5/Junior post and RD requirements is recommended including a standard template developed to promote equity. Professional standards emphasise some pillars of practice, such as clinical, more than others. Contribution of the Paper•Role descriptors for band 5/junior/recently qualified physiotherapists demonstrated wide heterogeneity in knowledge, skills, attributes and behaviours.•Analysis of RDs revealed high expectations of behaviours and attributes, and extensive pre-requisite knowledge and skills in qualified physiotherapists.•A review of Band 5 post and role descriptor requirements is recommended and a standard template developed and designed to promote equity.•Findings indicate that some areas of physiotherapy practice are featured less strongly in professional standards of practice than others. It is evident that some of the pillars of advanced practice, such as clinical practice, are weighted more heavily than others.

Illuminating an uncatalogued micropalaeontological collection at the Lapworth Museum of Geology, University of Birmingham

The Lapworth Museum of Geology (LMoG) at the University of Birmingham (UoB) holds &gt;300,000 specimens, including a sizable micropalaeontology collection. However, ~50% of the total LMoG collection is not digitised (e.g., there is no digital record) and thus inaccessible to external audiences. We contributed to the LMoG’s ongoing digitisation efforts by assessing the curation, historic and scientific significance of an uncatalogued assortment of “large” micropalaeontological specimens. We digitised and curated 219 specimens (comprising 307 parts) made up of hand specimens, containers and vials of loose fossils and sediment, and thin sections. The collection contained organisms from ten different phyla but was dominated by Larger Benthic Foraminifera (LBF). This dominance is reflected in the predominantly low-mid latitude geographic distribution of the collection, reflecting LBFs subtropical ecological preferences. The completeness of specimen metadata varied considerably with generally good geographic, chronostratigraphic, and taxonomic information at higher levels but poorer information with increasing detail and in relation to acquisition. Despite these limitations, we find that the studied collection was primarily assimilated for teaching purposes with donations from UoB staff and other specialist museums, and purchase from commercial dealers. There is little evidence for research on these specimens to date. Future work at the LMoG will digitise the collections and contribute to the ongoing efforts of international bodies to create large, open-access natural history datasets.

Preferences of Recent Mums in Remote and Rural Areas for Type of Intrapartum Care: A Discrete Choice Experiment.

Pregnant women living in rural areas considering their preferred place of birth may have to 'trade-off' travel time/distance and other attributes of care (e.g. the full choice of birthplace options is rarely available locally). This study assesses the preferences and trade-offs of recent mothers who live in remote and rural areas of Great Britain. An online survey, informed by qualitative research, was administered to women living in rural areas who had given birth in the preceding 3 years. The survey included a discrete choice experiment (DCE) to elicit women's preferences and trade-offs for place of birth. The DCE presented women with a series of eight choice tasks in which place of birth was defined by four attributes: (1) type of facility, (2) familiarity with staff, (3) understanding options and feel relaxed and reassured and (4) the travel time to the place of intrapartum care. DCE data were analysed using an error components logit model to identify preferences. Across 251 survey responses, holding everything else equal, respondents preferred: intrapartum care in locations with more specialist staff and equipment, locations where they understood their options and felt reassured and where travel time was minimal. Women were willing to travel (92-183 min) to a well-staffed and equipped facility if they understood their options and felt relaxed and reassured. Willingness to travel was reduced if the care received at the specialist facility was such that they did not understand their options and felt tense and powerless (41-132 min). These insights into the preferences of recent mums from remote and rural areas could inform future planning of rural intrapartum care.

The implementation of compulsory relationships and sex education in English secondary schools: qualitative research in the 2022–23 school year

ABSTRACT The quality of sex education varies. In England from 2020, the government attempted to improve provision by making lessons a statutory requirement. We assessed implementation in 25 secondary schools in 2022–23, framed by May’s general theory of implementation. This identifies processes of sense-making, cognitive participation, collective action and reflexive monitoring, influenced by an intervention’s capability, stakeholder potential (individual and collective commitment), and institutional capacity (norms, and material and cognitive resources). Interview data from staff leading relationships and sex education (RSE) were coded thematically informed by May’s concepts. Those leading implementation ‘made sense’ of statutory guidance, finding it relevant and clear. ‘Cognitive participation’ among participants was strong, promoted by individual support for RSE but undermined by social norms prioritising academic attainment, limited skills among non-specialist teachers, and lack of ‘collective commitment’ among some staff and students. ‘Collective action’ varied across schools, influenced by availability of material resources and specialist staff. Schools undertook internal the ‘reflexive monitoring’ of provision, supported by school leaders’ awareness work would be assessed by government inspectors. On its own, statutory status is likely insufficient to achieve a step-change in RSE implementation. Other forms of support may be needed including training and offering support to more specialist teachers.

Breaking the offending cycle

Expert examines the evidence for specialist staff to support neurodiverse young people in custody

Understanding the challenges of identifying, supporting, and signposting patients with alcohol use disorder in secondary care hospitals, post COVID-19: a qualitative analysis from the North East and North Cumbria, England

BackgroundAlcohol-related mortality and morbidity increased during the COVID-19 pandemic in England, with people from lower-socioeconomic groups disproportionately affected. The North East and North Cumbria (NENC) region has high levels of deprivation and the highest rates of alcohol-related harm in England. Consequently, there is an urgent need for the implementation of evidence-based preventative approaches such as identifying people at risk of alcohol harm and providing them with appropriate support. Non-alcohol specialist secondary care clinicians could play a key role in delivering these interventions, but current implementation remains limited. In this study we aimed to explore current practices and challenges around identifying, supporting, and signposting patients with Alcohol Use Disorder (AUD) in secondary care hospitals in the NENC through the accounts of staff in the post COVID-19 context.MethodsSemi-structured qualitative interviews were conducted with 30 non-alcohol specialist staff (10 doctors, 20 nurses) in eight secondary care hospitals across the NENC between June and October 2021. Data were analysed inductively and deductively to identify key codes and themes, with Normalisation Process Theory (NPT) then used to structure the findings.ResultsFindings were grouped using the NPT domains ‘implementation contexts’ and ‘implementation mechanisms’. The following implementation contexts were identified as key factors limiting the implementation of alcohol prevention work: poverty which has been exacerbated by COVID-19 and the prioritisation of acute presentations (negotiating capacity); structural stigma (strategic intentions); and relational stigma (reframing organisational logics). Implementation mechanisms identified as barriers were: workforce knowledge and skills (cognitive participation); the perception that other departments and roles were better placed to deliver this preventative work than their own (collective action); and the perceived futility and negative feedback cycle (reflexive monitoring).ConclusionsCOVID-19, has generated additional challenges to identifying, supporting, and signposting patients with AUD in secondary care hospitals in the NENC. Our interpretation suggests that implementation contexts, in particular structural stigma and growing economic disparity, are the greatest barriers to implementation of evidence-based care in this area. Thus, while some implementation mechanisms can be addressed at a local policy and practice level via improved training and support, system-wide action is needed to enable sustained delivery of preventative alcohol work in these settings.

중국의 법률구조제도

Legal aid refers to a social security system where legal support is provided by government-established legal aid agencies or law firm-affiliated lawyers to economically disadvantaged individuals or parties in special cases. However, China's legal aid system differs significantly from most countries. The Chinese government establishes legal aid centers, manages their operations, and bears the financial burden, including staff salaries, while encouraging private foundations to support legal aid activities. It also fosters the participation of private lawyers in legal aid by establishing various systems and mechanisms. The essence of legal aid is public service. China's legal aid system is undergoing several developmental stages to rapidly establish a comprehensive national system. The state first proposed the legal aid system, then implemented the &lt;Legal aid regulations&gt; followed by the enactment and promulgation of the &lt;Legal Aid Law of the people's Republic of China&gt;, clarifying the responsibilities and obligations of the state and individuals towards legal aid. National legal aid centers were established to employ specialized staff for legal aid work, allowing lawyers to handle legal aid cases or participate in legal aid consultations through these centers. Considering China's national policy, special legal aid systems have been established for various groups, like migrant workers and retired military personnel. To enhance efficiency and enable more citizens to access legal aid, legal service websites have been developed to provide online legal consultations. Additionally, a national public legal service hotline offers legal aid through phone consultations. Despite these developments, China's legal aid system faces numerous challenges due to its vast territory and large population, leading to imbalances in urban development and national income. This results in issues like staff and budget shortages in some legal aid centers. Therefore, a key future challenge is to make the national legal aid system more accessible to those in need and to develop solutions for issues related to manpower and budget.

Measuring and Analyzing the Impact of Government Public Spending on Higher Education and Its Role in Achieving Sustainable Development in Iraq for the Period (2003-2020)

Higher education institutions, especially universities, are an intellectual and scientific cultural center. The function of these institutions lies in behavioral and scientific aspects, such as building generations and developing scientific and cultural awareness in society, as higher education represents the most important pillars of the development of human societies and tools for their advancement due to the position it occupies in creating and preparing the technical and scientific frameworks qualified to achieve economic and social development. Developing and developed countries devote special efforts to supporting and developing the education sector, including Iraq, which gave increasing interest in the education sector, especially after 2003. This interest is attributed to the Iraqi government’s awareness that the reason for the country’s weak economic performance is the lack of cadres and levels of skilled labor that keep pace with the developments taking place. The world has led to a technological and knowledge gap with the developed world, and in order to achieve the process of sustainable development, education must be developed and expanded in its various stages and types, as it is the main source for providing the needs of the economic development sectors and supplying them with labor to implement sustainable development plans and in order to raise the educational level. Spending on the education sector must be increased to confront the rapid population growth, which leads to increased demand for educational services, which are among the rights guaranteed by the state to every individual, in addition to the need of developing countries, including Iraq, for specialized technical staff. The main problem for those countries is the role of education in achieving development in general and whether spending on education constitutes a burden on the sustainable development process in Iraq in particular. The results of the research indicated that there is a weakness in the process of government spending on higher education in Iraq, as the results showed research shows that the time series for the two variables are stable to the same degree; that is, there is a cointegration relationship between general government spending and spending on education, and the results were consistent with economic theory, as the relationship was positive and significant.

Potential Spatial Accessibility to Cardiovascular Hospitals in Romania

Cardiovascular diseases (CVDs) represent the leading cause of death globally. Romania recorded the highest mortality rate due to CVDs in the EU in 2022, with 162,984 deaths, while the number of registered patients with CVDs surpassed 4 million. This study aims to measure the population’s potential spatial accessibility to cardiovascular hospitals in Romania, as timely access to such healthcare facilities is crucial to minimise avoidable mortality due to CVDs. Although distance is an essential parameter of spatial accessibility, time-based analysis is more reflective of real-world scenarios due to the unpredictability of travel. The potential spatial accessibility was measured using the Application Program Interface (API) offered through the Google Maps platform and a personal car as the transportation mode. The country’s cardiovascular hospital network comprises 161 units, of which 84 can provide complex care. Because all of them are located in urban areas, three different time slots were considered to distinguish between high and low traffic congestion situations. We created hierarchies of ten-minute and five km intervals for travel time and distance, respectively, to emphasize the population percentages with better or low potential spatial accessibility. Results showed that only 15% of the population can reach the nearest cardiovascular hospital in less than 20 min, and 23% must travel for over 60 min, while 45.7% live farther than 20 km from a cardiovascular hospital. Inhabitants living in remote areas, especially rural ones, are the most vulnerable, having to travel for the longest time and distance. Actions like improving the existing transport infrastructure and upgrading healthcare facilities and equipment are needed to ensure better medical care and an adequate response to population needs. This study can support local authorities in optimising spatial accessibility to cardiovascular care by identifying the most burdened hospitals in the context of low medical specialised staff and large catchment areas.

Cancer in prison: barriers and enablers to diagnosis and treatment

Approximately 82,000 people are in prison annually in England and Wales. Limited research has investigated cancer in this population and none has explored experiences of imprisoned people with cancer. This study aimed to address this gap. We conducted 55 semi-structured, qualitative, audio-recorded interviews with: imprisoned people with cancer (n=24), custodial staff (n=6), prison healthcare staff (n=16) and oncology specialists (n=9). Data were collected 07/10/2019-20/03/2020. Patients were recruited by prison healthcare staff and interviews were conducted face-to-face. Professionals were recruited via professional networks and interviews were conducted face-to-face or via telephone. Transcribed interviews were analysed using reflexive thematic analysis. We also analysed relevant National Cancer Patient Experience Survey (NCPES) questions for those diagnosed in prison (n=78) and in the general population (n=390). Our findings highlight the complexities of cancer care for imprisoned people. We identified three core themes: control and choice, communication, and care and custody. Whilst people in prison follow a similar diagnostic pathway to those in the community, additional barriers to diagnosis exist including health literacy, the General Practitioner appointment booking system and communication between prison and oncology staff. Tensions between control and choice in prison impacted aspects of cancer care experience such as symptom management and accessing cancer information. NCPES results supported the qualitative findings and showed people in prison reported significantly poorer experiences than in the general population. Our findings demonstrate the complexity of cancer care in custodial settings, identifying barriers and enablers to equitable cancer care provision and offering insights on how to improve care for this population. National Institute for Health and Social Care Research Delivery Research Programme 16/52/53 and Strategic Priorities Fund 2019/20 Research England via University of Surrey.