System In England Research Articles

A Comparative Study of the Legal Effects of Trust with Deposit and Loan in the Legal Systems of Iran, France, and England

One of the contracts commonly used in various forms in society today is the contract of deposit. The Civil Code, from Article 607 onwards, defines this contract and explains its rulings and effects. Similarly, the concept of trust (Trust) is one of the fundamental and widely used concepts in the legal systems of countries like the United States and England, which are influenced by their legal system. In this institution, the owner, by relinquishing their ownership rights, subjects it to a trust and transfers their legal ownership rights to a person called the trustee. Loan, in the jurisprudence and law of Iran, refers to a revocable contract by which one party permits the other party to use the property without compensation for a specified period. Therefore, the author, in this article, compares the legal effects of trust with deposit and loan in the legal systems of Iran, England, and France in a descriptive-analytical manner. The results indicate that, according to English law and the resulting interpretations, trust is not considered a contract and can somewhat be categorized under agreements. Trust cannot be regarded as a real contract in the sense commonly used in Iranian law.

Comparative study of epilepsy registry system in America, England, Australia, and Iran.

Disease registries are one of the important steps in the development of health information systems. The aim of this study was to compare epilepsy registration systems in the United States, England, and Australia and propose a National Epilepsy Registry System for Iran. This study was a descriptive-comparative study conducted between 2020 and 2023, which involved the following steps: identification and selected countries with advanced registry systems in the world and Identification of their characteristics and comparison with each other. The research population included the epilepsy registration registry in Australia, England, the United States, and Iran. In this study, data were collected from forms, observations, and documents. In Australia, all databases, reports, and minimum datasets are electronically sent to the Australian Epilepsy Register. In England, the Epilepsy Society is responsible for collecting information. In the United States, all individuals with epilepsy voluntarily send their information to registry centers and the Epilepsy Society to help with their treatment. However, there is no national epilepsy registry system in Iran. Therefore, recommendations have been made to establish. Registration systems can help collect and analyze data related to all patients with a particular disease. When this registration is established at the national level, it becomes a valuable clinical tool for improving the quality of care and can be a significant step toward managing care for epilepsy patients and healthcare centers. Indeed, such a system can also help in preventing the onset of epilepsy and planning for the improvement of the quality of life for patients.

Riding Jane Eyre's Stagecoach Rhythm in Jane Re's New York Subway

In the Victorian era, innovations in infrastructure, notably the revolutionary stagecoach, redefined women's travel experiences and offered them a means to break free from domesticity. While the rapid pace of the stagecoach initially unsettles individuals like Jane Eyre in Charlotte Brontë's Jane Eyre (1847), she accustoms herself to its motion to evade perilous situations. Bearing in mind the cadence of the stagecoach, I suggest that Patricia Park's modern retelling of Jane Eyre, Re Jane (2015), adapts the rhythm of the coach by recasting it as the motion of the New York City subway. Revising in this way, Park incorporates positive racial representation through the subway and its passengers. By re-creating the rhythm of the coach through the subway train, Park considers two historical ideas: the New York City subway was built by racial and ethnic minorities such as Irish immigrants and African Americans, and the subway also softly calls back to the beginnings of the American transcontinental railroad that erased the visibility of Chinese immigrant laborers. This essay contends that the transportation systems in nineteenth-century England and twenty-first-century New York created changes that liberated women from the rooted domestic ideologies of their respective periods.

The quest for certainty: Introducing zoning into a discretionary system in England and the European experience

The critique of planning and new proposals to reform the English planning system and “rethink planning from first principles” have led to the introduction of rules-based principles into what is regarded as the paradigm of a discretionary planning system, culminating in a recent White Paper, which it is claimed will create a faster and better planning system than the existing discretionary approach. But are these proposals based on an oversimplified understanding of the differences between discretionary and regulatory models, neglecting, for example, the negotiation between stakeholders and the flexibility which also exists in regulatory planning systems? Our contribution will review some of the recent changes of the English planning system and reflect on experiences with zoning in European countries to bust the myth that the planning reform claims to address: the possibility to combine faster decision making with better place making and less interference from local planning authorities.

Integrated Care Systems in England: Progress towards forming new multi-stakeholder partnerships to develop quality.

Background: Health and social care services in England have been restructured to 42 Integrated Care Systems (ICS). ICSs are responsible for delivering integrated services in their local area to prevent illness; identify and treat illness effectively; and provide support to improve quality of life for people with long-term illness or disability. Under the umbrella of ICSs, previously siloed organisations need to work together to deliver quality care. This study aimed to understand how these new ways of working impact on the development of their quality agenda.
 Methods: Semi-structured interviews were undertaken with senior representatives in demographically and geographically diverse ICS. Interviews were audio recorded, transcribed verbatim and analysed in NVivo using a thematic framework approach. Two Patient and Public Involvement team members contributed to the study design and data analysis. The study is conducted at two points in time; the data reported here is the baseline collected shortly (November 2021 to May 2022) before the ICSs’ formal constitution in July 2022.
 Results: Sixty interviews across four ICSs were conducted with senior representatives (e.g. ICS CEO, chief nurse, quality leads, director of social services, director of public health, the public and local communities). Across all ICSs, progress had been made with creating ICS specific committees, with new roles created and leaders appointed, and new partnerships emerging. Positive learning on collaborating with diverse partners had occurred during the COVID-19 pandemic and through previous local initiatives to integrate services. In two ICSs, there was less history of such collaborative work and their new partnerships were emerging more slowly. 
 Generally, it was agreed that strong leadership, supported by broad and effective system partnerships, was essential to develop the ICSs’ structure and to deliver quality. Key partners to support the leadership were senior partners in acute hospital trusts, primary care, social care, public health, Healthwatch (the health and social care champion for service users), voluntary services, and patient representatives. 
 Some concerns were raised that made collaborations more challenging, including differences in language and work culture between the key partners, and health dominating the quality agenda. Overall, it was felt that social care, public health and voluntary services were heard less. They were being consulted, but rarely had leadership roles and leaders from these communities often felt that they were not equal partners. Most participants highlighted the importance of consulting patients and the public and acknowledged that this was not done effectively yet with too few people, who lacked diversity, consulted; and an overreliance on Healthwatch. 
 Discussion: This restructure of the health and social care system shows that new partnerships can be formed between previously siloed organisations but that these take time to develop. In particular, organisations or people who have traditionally been less consulted such as social care, public health, and patients and the public still need to become more equal partners in developing the quality agenda. Follow up interviews will bring greater clarity on how this restructure will maintain and promote quality across services. 

Potential contribution of vaccination uptake to occupational differences in risk of SARS-CoV-2: analysis of the ONS COVID-19 Infection Survey

ObjectivesTo assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection.DesignWe analysed data from the UK Office of National Statistics COVID-19...

An Attempt to Learn the Education System of England from the Perspective of a Turkish-Born Teacher and a Teacher Candidate: A Comparative Narrative Approach

An Attempt to Learn the Education System of England from the Perspective of a Turkish-Born Teacher and a Teacher Candidate: A Comparative Narrative Approach

Non-medical practitioners in the staffing of emergency departments and urgent treatment centres in England: a mixed qualitative methods study of policy implementation

BackgroundPatient demand, internationally, on emergency departments and urgent care treatment centres has grown. Shortages of staff, particularly of emergency medicine doctors, have compounded problems. Some countries are pursuing solutions of including non-medical practitioners e.g., nurse practitioners and physician associates/assistants in their emergency department workforces. This study investigated at the macro and meso level of the health system in England: what the rationale was and the factors influencing the current and future employment, or otherwise, of non-medical practitioners in emergency departments and urgent treatment centres.MethodsMixed qualitative methods in the interpretative tradition were employed. We undertook, in 2021–2022, a documentary analysis of national, regional and subregional policy (2017–2021), followed by semi-structured interviews of a purposive sample (n = 18) of stakeholders from national, regional and subregional levels. The data were thematically analysed and then synthesised.ResultsThere was general national policy support for increasing the presence of non-medical practitioners as part of the solution to shortages of emergency medicine doctors. However, evidence of policy support dissipated at regional and subregional levels. There were no published numbers for non-medical practitioners in emergency departments, but stakeholders suggested they were relatively small in number, unevenly distributed and faced uncertain growth. While the experience of the COVID-19 pandemic and its aftermath were said to have made senior decision makers more receptive to workforce innovation, many factors contributed to the uncertain growth. These factors included: limited evidence on the relative advantage of including non-medical practitioners; variation in the models of service being pursued to address patient demand on emergency departments and the place of non-medical practitioners within them; the lack of a national workforce plan with clear directives; and the variation in training for non-medical practitioner roles, combined with the lack of regulation of that level of practice.ConclusionsWe identified many features of a system ready to introduce non-medical practitioners in emergency departments and urgent treatment centres but there were uncertainties and the potential for conflict with other professional groups. One area of uncertainty was evidence of relative advantage in including non-medical practitioners in staffing. This requires urgent attention to inform decision making for short- and long-term workforce planning. Further investigation is required to consider whether these findings are generalisable to other specialties, and to similar health systems in other countries.

Prerequisites and practice of introducing integrated systems of medical care in England

The introduction of new conceptual approaches to public health protection is a trend of public health reform in Russia and European countries. The success of the implementation of public health policy in Russia depends both on the development of their own ideas and their implementation, on the study and use of the experience of foreign countries. For example, in England in the last decade, as part of the reform of the public health system, the idea of creating integrated medical care systems (ICS) has been actively developing and the experience of its implementation is of practical interest for Russian healthcare. 
 Goal. To study the experience of England in implementing integrated medical care systems and analyze the possibility of using its individual elements in Russia. 
 Materials and methods. The study was conducted on the basis of a comprehensive study of open reporting data of the Department of Health and Social Security of England, the National Health Service and the National Audit Office of England (NAO), as well as scientific reports on integrated public health management systems. 
 Results. The development of integrated public health management systems being a trend in world practice, contributes to the improvement of public health indicators. The study of the experience of implementing ICS in England showed the presence of a number of risks during its implementation.
 Limitations. When conducting research, there were no restrictions that could influence the preparation of the article.
 Conclusions. Dissatisfaction with the level of management and financing of the healthcare system in England served as an impetus for the start of reforms that contribute to improving the management of medical care to the population, and the introduction of integrated medical care systems. The analysis of the NAO auditors revealed the main risks of the success of the ICS implementation. Studying the experience of implementing ICS is useful for use in the implementation of Russian national projects in the field of healthcare and demography.

General practice in an integrated NHS: reasons to be hopeful

Moving from leadership of general practice to leadership involving all medical disciplines throughout the Coronavirus 2019 (COVID-19) pandemic provided a fascinating overview of the health and care landscape. There are many erroneous assumptions in secondary care about general practice, and vice versa, with professional tribalism a cause for concern. However, there are many examples of effective and straightforward integration, and the establishment of integrated care systems in England has provided a unique opportunity to address the commissioning challenges that had previously been barriers.

Assessing progress in managing and improving quality in nascent integrated care systems in England.

In 2022, England embarked on an ambitious reorganisation to produce an integrated health and care system, intended also to maximise population health. The newly created integrated care systems (ICSs) aim to improve quality of care, by achieving the best outcomes for individuals and populations through the provision of evidence-based services. An emerging approach for managing quality in organisations is the Quality Management System (QMS) framework. Using the framework, this study assessed how ICSs are managing and improving quality. Four ICSs were purposively sampled, with the data collected between November 2021 and May 2022. Semi-structured interviews with system leaders (n=60) from health and social care, public health and local representatives were held. We also observed key ICS meetings and reviewed relevant documents. A thematic framework approach based on the QMS framework was used to analyse the data. The ICSs placed an emphasis on population health, reducing inequity and improving access. This represents a shift in focus from the traditional clinical approach to quality. There were tensions between quality assurance and improvement, with concerns that a narrow focus on assurance would impede ICSs from addressing broader quality issues, such as tackling inequalities and unwarranted variation in care and outcomes. Partnerships, a key enabler for integration, was seen as integral to achieving improvements in quality. Overall, the ICSs expressed concerns that any progress made in quality development and in improving population health would be tempered by unprecedented system pressures. It is unclear whether ICSs can achieve their ambition. As they move away from an assurance-dominated model of quality to one that emphasises openness, learning and improvement, they must simultaneously build the digital infrastructure, staff expertise and culture to support such a shift.

Developing a risk prediction tool for lung cancer in Kent and Medway, England: cohort study using linked data

BackgroundLung cancer has the poorest survival due to late diagnosis and there is no universal screening. Hence, early detection is crucial. Our objective was to develop a lung cancer risk prediction tool at a population level.MethodsWe used a large place-based linked data set from a local health system in southeast England which contained extensive information covering demographic, socioeconomic, lifestyle, health, and care service utilisation. We exploited the power of Machine Learning to derive risk scores using linear regression modelling. Tens of thousands of model runs were undertaken to identify attributes which predicted the risk of lung cancer.ResultsInitially, 16 attributes were identified. A final combination of seven attributes was chosen based on the number of cancers detected which formed the Kent & Medway lung cancer risk prediction tool. This was then compared with the criteria used in the wider Targeted Lung Health Checks programme. The prediction tool outperformed by detecting 822 cases compared to 581 by the lung check programme currently in operation.ConclusionWe have demonstrated the useful application of Machine Learning in developing a risk score for lung cancer and discuss its clinical applicability.

Comparison of surveillance systems for monitoring COVID-19 in England: a retrospective observational study

During the COVID-19 pandemic, cases were tracked using multiple surveillance systems. Some systems were completely novel, and others incorporated multiple data streams to estimate case incidence and prevalence. How well these different surveillance systems worked as epidemic indicators is unclear, which has implications for future disease surveillance and outbreak management. The aim of this study was to compare case counts, prevalence and incidence, timeliness, and comprehensiveness of different COVID-19 surveillance systems in England. For this retrospective observational study of COVID-19 surveillance systems in England, data from 12 surveillance systems were extracted from publicly available sources (Jan 1, 2020-Nov 30, 2021). The main outcomes were correlations between different indicators of COVID-19 incidence or prevalence. These data were integrated as daily time-series and comparisons undertaken using Spearman correlation between candidate alternatives and the most timely (updated daily, clinical case register) and the least biased (from comprehensive household sampling) COVID-19 epidemic indicators, with comparisons focused on the period of Sept 1, 2020-Nov 30, 2021. Spearman statistic correlations during the full focus period between the least biased indicator (from household surveys) and other epidemic indicator time-series were 0·94 (95% CI 0·92 to 0·95; clinical cases, the most timely indicator), 0·92 (0·90 to 0·94; estimates of incidence generated after incorporating information about self-reported case status on the ZoeApp, which is a digital app), 0·67 (95% CI 0·60 to 0·73, emergency department attendances), 0·64 (95% CI 0·60 to 0·68, NHS 111 website visits), 0·63 (95% CI 0·56 to 0·69, wastewater viral genome concentrations), 0·60 (95% CI 0·52 to 0·66, admissions to hospital with positive COVID-19 status), 0·45 (95% CI 0·36 to 0·52, NHS 111 calls), 0·08 (95% CI -0·03 to 0·18, Google search rank for "covid"), -0·04 (95% CI -0·12 to 0·05, in-hours consultations with general practitioners), and -0·37 (95% CI -0·46 to -0·28, Google search rank for "coronavirus"). Time lags (-14 to +14 days) did not markedly improve these rho statistics. Clinical cases (the most timely indicator) captured a more consistent proportion of cases than the self-report digital app did. A suite of monitoring systems is useful. The household survey system was the most comprehensive and least biased epidemic monitor, but not very timely. Data from laboratory testing, the self-reporting digital app, and attendances to emergency departments were comparatively useful, fairly accurate, and timely epidemic trackers. National Institute for Health and Care Research Health Protection Research Unit in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, King's College London, and the University of East Anglia.

Long-term healthcare utilization and costs of babies born after assisted reproductive technologies (ART): a record linkage study with 10-years' follow-up in England.

Is the long-term health care utilization of children born after ARTmore costly to the healthcare system in England than children born to mothers with no fertility problems? Children born after ART had significantly more general practitioner (GP) consultations and higher primary care costs up to 10 years after birth, and significantly higher hospital admission costs in the first year after birth, compared to children born to mothers with no fertility problems. There is evidence that children born after ART are at an increased risk of adverse birth outcomes and a small increased risk of rare adverse outcomes in childhood. We conducted a longitudinal study of 368088 mother and baby pairs in England using a bespoke linked dataset. Singleton babies born 1997-2018, and their mothers, who were registered at GP practices in England contributing data to the Clinical Practice Research Datalink (CPRD), were identified through the CPRD GOLD mother-baby dataset; this data was augmented with further linkage to the mothers' Human Fertilisation and Embryology Authority (HFEA) Register data. Four groups of babies were identified through the mothers' records: a 'fertile' comparison group, an 'untreated sub-fertile' group, an 'ovulation induction' group, and an ART group. Babies were followed-up from birth to 28 February 2021, unless censored due to loss to follow-up (e.g. leaving GP practice, emigration) or death. The CPRD collects anonymized coded patient electronic health records from a network of GPs in the UK. We estimated primary care costs and hospital admission costs for babies in the four fertility groups using the CPRD GOLD data and the linked Hospital Episode Statistics (HES) Admitted Patient Care (APC) data. Linear regression was used to compare the care costs in the different groups. Inverse probability weights were generated and applied to adjust for potential bias caused by attrition due to loss to follow-up. Children born to mothers with no fertility problems had significantly fewer consultations and lower primary care costs compared to the other groups throughout the 10-years' follow up. Regarding hospital costs, children born after ART had significantly higher hospital admission costs in the first year after birth compared to those born to mothers with no fertility problems (difference = £307 (95% CI: 153, 477)). The same pattern was observed in children born after untreated subfertility and ovulation induction. HFEA linkage uses non-donor data cycles only, and the introduction of consent for data use reduced the availability of HFEA records after 2009. The fertility groups were derived by augmenting HFEA data with evidence from primary care records; however, there remains some potential misclassification of exposure groups. The cost of neonatal critical care is not captured in the HES APC data, which may cause underestimation of the cost differences between the comparison group and the infertility groups. The findings can help anticipate the financial impact on the healthcare system associated with subfertility and ART, particularly as the demand for these treatments grows. C.C. and this work were funded by a UK Medical Research Council Career Development Award [MR/L019671/1] and a UK MRC Transition Support Award [MR/W029286/1]. X.H. is an Australia National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow [grant number 2009253]. The authors declare no competing interest. N/A.

Beyond the threshold: The implications for pupil achievement of reforming school performance metrics

We study the effects of a major change to the school accountability system in England. In 2015, the leading published school performance metric was switched from a threshold measure (essentially the fraction of students above a test score level) to an average score measure. Using 7 years of data on all secondary schools in England, we show that this intervention relatively reduced the test scores of students near the threshold, in favour of groups above the threshold (marginally) and below (substantially). We check the sensitivity of our results to different decisions, and present findings on heterogeneous treatments.

Collaborative Leadership in Integrated Care Systems; Creating Leadership for the Common Good

ABSTRACTThe COVID-19 pandemic has become a catalyst for change, but such change can only happen through collaborative leadership which maintains a focus on relationships and purpose rather than solely on outputs or outcomes. This conceptual article explores how health and social care integration has been offered as one potential solution to the challenge of health and social care transformation. Specifically, Integrated Care Systems in England are intended to provide regional governance, to provide public services in a coherent and robust way. We explore this development in relation to three key aspects: the macro-level global policy context; the meso-level organizational behaviour and culture; and the micro-level practice of individual leaders and managers. It is found that, whilst the organizational structure of Integrated Care Systems offers great promise, collaborative leadership is critical to realize truly resilient and sustainable collaborative relationships.MAD statementIntegrated Care Systems have been developed at the system level with little consideration of the leadership that will be required to implement collaborative action across health and social care. Coming out of the COVID-19 crisis there is an opportunity to create leadership for the common good – but this will require energy, purpose, and courage across all levels of the governance system.

Outside-in: Co-production and the spatial planning systems in Italy and England

This article concerns the growing interest in ‘co-production’ in spatial planning, focusing on its relationship with planning systems. The article refers to Italy and England – two institutional contexts with different planning systems – and concludes that co-production can operate outside or inside the planning system. Both models have pros and cons. However, the critical factor determining co-production regarding the planning system appears to be related to how land use rights are allocated. While prior allocation through prescriptive plans keeps co-production out of the system, only allocation as a final case-by-case decision allows co-production to be part of it.

A national data linkage study to assess the extent, nature and outcomes of serious and organised crime prosecuted before the criminal courts in England and Wales

ObjectivesThe social and economic costs associated with serious and organised crime (SOC) are considerable: recently estimated by the National Audit Office to be £37 billion annually. Despite this, we know little about the extent and nature of SOC being prosecuted before the courts, or the outcomes associated with these cases.
 MethodsSecondary analysis of over 12.6 million linked, individual-level, de-identified records from the Data First initiative relating to the criminal courts and prison system in England and Wales (E&W) over an eight-year period (2013-2020).
 ResultsThis unique study provides estimates for the rate and volumes of SOC appearing before the Crown Court in E&W and describes the characteristics of the defendants charged with these offences, and their associated outcomes. Using a comparative design, the study also assessed the severity and geographic distribution of offending associated with SOC; the extent to which prosecutions were discontinued, dismissed, or resulted in an acquittal (and the factors most predictive of this outcome); and the rate and frequency of reappearances before the criminal courts over time.
 ConclusionThe findings contribute towards enhancing government and law enforcement resilience in this area by developing a better understanding of SOC and the effectiveness of responses to it. This evidence informs key Ministry of Justice priorities linked to the effective and efficient delivery of justice and upholding the rule of law.

'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands.

Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.

Impact of Voluntary, Community and Social Enterprise (VCSE) Organisations Working with Underserved Communities with Type 2 Diabetes Mellitus in England.

The Voluntary, Community and Social Enterprise (VCSE) sector offers services and leadership within the health and care system in England and has a specialist role in working with underserved, deprived communities. This evaluation aims to identify best practices in self-management support for those living with type 2 diabetes mellitus (T2DM) and to develop a theory of change (TofC) through understanding the impact of VCSE organisations on diabetes management. An appreciative inquiry (AI) was carried out and co-delivered using qualitative interviews and an embedded analysis with VCSE partners. A voluntary service coordinated seven VCSE organisations who assisted with recruiting their service users and undertook interviews to identify the impact of existing activities and programmes. People living with T2DM were interviewed about services. Themes were as follows: (a) individual and group activities; (b) trusted services and relationships across the community; (c) long-term engagement; (d) sociocultural context of diet and nutritional choices; (e) experience of adaptation; and (f) culturally appropriate advice and independent VCSE organisations. The structured educational approach (DESMOND) for T2DM was accessed variably, despite these services being recommended by NICE guidelines as a standard intervention. The VCSE offered continuity and culturally appropriate services to more marginalised groups. This evaluation highlights the importance of targeted engagement with underserved communities, particularly where primary care services are more limited. The TofC is a unique insight into the impact of VCSE services, offering bespoke support to manage T2DM, suggesting areas for improvements in capacity and offering the capability to sustain the VCSE sector as an essential element of the T2DM care pathway in England.