Transformation Partnerships Research Articles

Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system.

To investigate how health and care leaders navigate the micro-politics of major system change (MSC) as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service (NHS). A comparative qualitative case study of three STPs carried out between 2018-2021. Data collection comprised 72 semi-structured interviews with STP leaders and stakeholders; 49h of observations of STP executive meetings, management teams and thematic committees, and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the 'disagreements, 'people and interests' and the 'skills, behaviours and practice'. Three linked political fault-lines underpinned the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers, and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position. Given the lack of formal authority and breadth of system change, navigating the micro-politics of MSC requires political skills in listening and engagement, strategic appraisal of the political landscape and effective negotiation and consensus-building.

Beyond the Deliverable

Those who participate in service-learning/civic engagement (SLCE) in engineering have a common practice of reflecting on partnerships to determine if they were successful and how they might be improved. But what makes a partnership successful? We wanted to learn more about how and why to quantify partnership success to think “beyond the deliverable,” which is often the singular focus of engineering SLCE projects. To this end, we created a rubric for three dimensions of partnership that we selected after consulting engagement partnership literature: transactional, cooperative, and transformational. Using this rubric, we assessed the 55 completed partnerships of the LSU Community Playground Project (LSUCPP) by plotting scores in a 3-axis coordinate system (transactional as the x-axis, cooperative as the y-axis, and transformational as the z-axis) where a placement closer to (3.0, 3.0, 3.0) means a more universally successful partnership. Within each dimension of partnership, we assessed design, people, and process in equal measure to ensure that we paid adequate attention to each of these key aspects of engineering SLCE efforts. Further, part of this assessment involved surveying constituents (community partners, students, and faculty) about the transformational dimension of completed partnerships. Results showed that our partnerships had high transactional (2.4) and cooperative (2.5) mean scores overall, with a lower transformational mean (1.8). We also identified a transactional/cooperative threshold (2.0/2.0) at which the chance of having a transformational partnership went up; overall, our percentage of highly (2.0 or higher) transformational partnerships was 58%, but 70% of our partnerships that reached the threshold were highly transformational. The aspects of transformation most often identified by our survey respondents included building your capacity personally (81%), building lasting connections with colleagues (73%), and building your capacity professionally (70%). We believe that the method of holistic assessment for community-university partnerships presented here can lead to better engaged partnerships and can be adapted by others who wish to improve their SLCE engineering partnerships.

Toward Transformative Engagement: Ethical and Effective Clinical-Research Partnerships in Cancer Care Nursing

Background: Clinical nurses have the potential to conduct impactful practice-focused research, enhancing institutional research cultures and improving patient outcomes. However, collaboration between clinical nurses and academic nurse scientists can be challenging and resource intensive. Objective: Describe how transformative clinical-research partnership facilitates achieving mutual goals for clinical nurses and academic nurse scientists. Methods: The Virtual Supportive Cancer Care Research (ViSuCaRe) Study, a multisite, mixed-method study, was conducted through a clinical-research partnership to explore the experience of patients and clinicians engaging in supportive cancer care via telehealth during the COVID-19 pandemic. Results: We describe research and quality improvement products and identify how the ViSuCaRe Study addressed three common challenges to clinical-research partnerships. (1) Study conception, construction, and development prioritized frontline clinical staff involvement; (2) Data collection and analysis engaged clinical partners in recruitment, interviewing, data management, coding, and theory-building; (3) Subsequent analyses, products, and dissemination efforts emerged from evolving needs of clinical partners and shifted in accordance with their arising priorities. Conclusions: Using an approach to collaboration centered on transformative engagement offers clinical nurses and academic nurse scientists. Implications for Practice: Frontline clinical staff should have consistent and meaningful roles in developmental, analytic, and dissemination-directing processes. Supporting clinical nurses’ engagement in research activities will enable them to identify and address problems that impact practice, enhance research cultures, and promote evidence-based practice. Foundational: Using a model of transformative engagement, rooted in community engagement, allows nurses to carry out collaborative practice-focused research. Clinical-academic partnerships offer an economical approach to enhancing clinical nurses’ research capacities.

Toward a Critical Race RPP: how race, power and positionality inform Research Practice Partnerships

ABSTRACT This research article challenges the normative construction of RPPs as an inherently equitable, post-racial and ungendered methodological framework. By utilizing critical race theory broadly, and whiteness as property in particular, we highlight how without explicit consideration for the racialization of research identities, RPPs are incapable of disrupting oppressive power structures that hinder equity and social change. As WOC researchers working on a large National Science Foundation granted study, we witnessed two issues in RPP methodologies: (1) institutional power granted by Academe is negated when whiteness is prioritized and minoritized race/gender identities are involved; and (2) niceness is weaponized as a means of protecting education and research as the property of whites in order to maintain the status quo. By utilizing our counterstories to unpack and interrogate the onto-epistemological and sociopolitical infrastructure of RPPs, we offer implications and best practices for how to foster more transformative and racially-just research partnerships. Specifically, we use CRT to theorize a Critical Race-RPP (CR-RPP) methodology that seeks to decentre whiteness and privilege the voices and needs of People of Color and other marginalized communities within schools and academia.

Professional perspectives on impacts, benefits and disadvantages of changes made to community continence services during the COVID-19 pandemic: findings from the EPICCC-19 national survey

BackgroundThe COVID-19 pandemic required changes to the organisation and delivery of NHS community continence services which assess and treat adults and children experiencing bladder and bowel difficulties. Although strong evidence exists for the physical and mental health benefits, improved quality of life, and health service efficiencies resulting from optimally organised community-based continence services, recent audits identified pre-pandemic pressures on these services. The aim of this study was to explore professional perceptions of changes made to community continence services due to the COVID-19 pandemic and consequent impacts on practice, care provision and patient experience.MethodsOnline survey of 65 community continence services in England. Thematic analysis using constant comparison of open-ended questions. Frequency counts of closed-ended questions.ResultsSixty-five services across 34 Sustainability and Transformation Partnership areas responded to the survey. Use of remote/virtual consultations enabled continuation of continence care but aspects of ‘usual’ assessment (examinations, tests) could not be completed within a remote assessment, requiring professionals to decide which patients needed subsequent in-person appointments. Remote appointments could increase service capacity due to their time efficiency, were favoured by some patients for their convenience, and could increase access to care for others. However, the limited ability to complete aspects of usual assessment raised concerns that diagnoses could be missed, or inappropriate care initiated. The format also restricted opportunities to identify non-verbal cues that could inform professional interpretation; and made building a therapeutic relationship between professional and patient more challenging. Remote appointments also posed access challenges for some patient groups. A third of participating services had experienced staff redeployment, resulting in long wait times and some patients being left without care; or reported additional caseload, which had delayed care provision for patients with continence issues. Participants perceived continence care to have been deprioritised, and more generally undervalued, and called for greater recognition of the impact of continence care.ConclusionsRemote appointments offer efficiency and convenience. However, ‘in-person’ approaches are highly valued for optimum quality, patient-centred continence care, and good team relationships. Failure to restore redeployed continence staff will diminish patient health and quality of life, with associated costs to the NHS.

Building Community Power to Achieve Health and Racial Equity: Principles to Guide Transformative Partnerships with Local Communities.

Building Community Power to Achieve Health and Racial Equity: Principles to Guide Transformative Partnerships with Local Communities.

Transformative Partnerships: Expanding Extension’s Capacity to Support Texans with Developmental Disabilities

New partnerships to reach new audiences are key to Extension’s future (Harder, 2019). But partnership is enhanced through shared decision-making, co-creation of content, and leveraging non-overlapping expertise and experience (Bertsch et al., 2020; Israilov & Cho, 2017; Ostrom, 1996). Texas A&M AgriLife Extension Service partnering with the Texas Council for Developmental Disabilities provides a novel approach to using statewide presence to the benefit of a partner seeking to expand its footprint (Alford, 2014; Ostrom, 1996) and is, itself, an outcome (Voorberg et al., 2015). Additionally, Texans with disabilities benefit through greater access to the education and resources the partnership produces.

Healthcare Leadership with Political Astuteness and its role in the implementation of major system change: the HeLPA qualitative study

BackgroundThe implementation of change in health and care services is often complicated by the ‘micropolitics’ of the care system. There is growing recognition that health and care leaders need to develop and use types of ‘political skill’ or ‘political astuteness’ to understand and manage the micropolitics of change.AimThe aim of this study was to produce a new empirical and theoretical understanding of the acquisition, use and contribution of leadership with ‘political astuteness’, especially in the implementation of major system change, from which to inform the co-design of training, development and recruitment resources.MethodsThe qualitative study comprised four work packages. Work package 1 involved two systematic literature reviews: one ‘review of reviews’ on the concept of political astuteness and another applying the learning from this to the health services research literature. Work package 2 involved biographical narrative interviews with 66 health and care leaders to investigate their experiences of acquiring and using political skills in the implementation of change. Work package 3 involved in-depth qualitative case study research with nine project teams drawn from three regional Sustainability and Transformation Partnerships operating in different English regions. Work package 4 involved a series of co-design workshops to develop learning materials and resources to support service leaders’ acquisition and use of political skills and astuteness.ResultsThe concepts of political skills and astuteness have had growing influence on health services research, yet these have tended to emphasise a relatively individualised and behavioural view of change leadership. The interview study suggests that, although leaders certainly use individual skills and behaviours when implementing change, change processes are contingent on local contextual factors and the patterns of collective action in the forms of interlocking constellations of political interactions. The in-depth case study research further shows these interactive, contingent and collective processes in the implementation of major system change. The study finds that major system change occurs over several linked stages, each involving particular controversies for which skills, strategies and actions are needed. Informed by these findings, and through a series of co-design workshops, the study has produced a set of resources and materials and a workbook to support individuals and project teams to acquire and develop political skill.LimitationsThe study was complicated by the COVID-19 pandemic and there were difficulties in recruiting in-depth cases for observational research, and also recruiting patient and community groups.ConclusionsHealth and care leaders can develop and use a range of skills, strategies and actions to understand and navigate the diverse interests that complicate change. Building on the literature, the study presents a novel empirical framework of these skills, strategies and behaviours, and shows how they are used in the implementation of major system change. This study concludes with a set of co-designed learning resources and materials to support future leaders to develop similar skills and strategies. Further evidence is needed on the contribution of the learning resources on leadership activities and to understand the contribution of political skills to other areas of service governance.Study registrationThis study is registered as researchregistery4020.FundingThis project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full inHealth and Social Care Delivery Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.

The Research on the Role Status of China’s Software Service Outsourcing Based on the Partnership of Service Outsourcing Networks

China has been greatly engaging in global outsourcing services. Despite the increase in global outsourcing services industry, yet the service trade is in deficit and the export trades in service mainly concentrate on the travel, transportation and other business service, both of which indi-cate the comparatively low competitiveness of Chinese service in the world. The nature of partnerships involved between China’s service business undertakers and their overseas clients have not received adequate attention in the scholarly literature. The study analyzed three possible types of outsourcing networks partnership which include tactical, strategic and transformational partnership. Based on software development “waterfall model”, the network role status in undertaking outsourcing service of China are explained and the analysis results show that the tactical partnership plays a key role on the value chain of China’s software outsourcing in the global networks. It is concluded that China’s low value chain in software outsourcing networks is determined by the tactical partnership. Some suggestions on how to improve China’s software outsourcing industry include culti-vating the leading enterprises, building up an intermediary organization, enlarging the clustering effect in industrial park and taking advantage of the Belt and Road Initiative market and Japanese market.

Barriers and facilitators of use of analytics for strategic health and care decision-making: a qualitative study of senior health and care leaders’ perspectives

ObjectiveThis study investigated the barriers and facilitators that senior leaders’ experience when using knowledge generated from the analysis of administrative health or care records (‘analytics’) to inform strategic health and...

Creating Transformative Service-Learning Partnerships as a Force for Change in Higher Education

Service-Learning to Advance Access and Success: Bridging Institutional and Community Capacity addresses how partnerships between institutions and communities can be leveraged to build community capacity as well as how institutions might build their own capacity to effect change for the good of society. Case studies detailed in the book explore the relationship between service-learning pedagogy and student access and success. Together, the chapters serve as a call to action to make more collaborative and sustainable efforts toward meaningful integration of service-learning into the curriculum and campus culture while providing practical advice on how to do so successfully.

Challenges and chances for local health and social care integration – Lessons from Greater Manchester, England

PurposeSustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.Design/methodology/approachDocumentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.FindingsThe study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.Research limitations/implicationsThe findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.Originality/valueThis study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.

“School’s a Lie”: Toward Critical Race Intersectional Pedagogy for Youth Intellectual Activism in Policy Partnerships

Equity-oriented school improvement driven by neoliberal policies focuses attention on a narrow range of inequities. Such policies fail to achieve substantive transformations that address educational constraints experienced by multiply-marginalized youth of color. We engage a critical race and intersectional feminist examination of our pedagogy in a youth voice initiative designed to facilitate multiply-marginalized youth of color participation in district policy partnership. Our analysis presents practices that were consequential for supporting youth intellectual activism in policy conversations. We propose a model for critical race intersectional pedagogy that relates these practices and underlying ideological principles to supporting expansive transformative policy partnerships.

Local authority research systems: a qualitative study to inform the development of a South Gloucestershire Council-wide research system

BackgroundThe co-location of expertise in public health, social care, and place services in local authorities facilitates tackling the wider determinants of health using transdisciplinary approaches. Local authority research systems are needed to enable local authorities to become research active, co-produce research, evaluate their impact, and produce and use evidence to shape practice and policy at pace. We aimed to explore and recommend what is necessary for a South Gloucestershire Council (SGC) research system to sustainably produce impactful research activity. MethodsWe did qualitative interviews with elected members and senior leadership of SGC and key stakeholders from local National Institute for Health Research (NIHR) infrastructure and organisations identified by expert sampling. Interviews were semi-structured with tailored topic guides exploring several topics, including relationships between SGC and local partners, resource and support, co-production, social care research, and the impact of COVID-19. Data from interviews were electronically transcribed verbatim using Otter.ai and coded using NVivo qualitative data analysis software. Data were analysed using the framework method and recommendations were proposed based on the findings. Ethical approval was granted by the University of Bristol's Faculty of Health Science Research Ethics Committee. FindingsWe interviewed 27 participants (five from SGC, 22 from local research organisations). Participants identified a need for a SGC research lead to facilitate collaboration and relationship building, and more joint posts across the local authority and external organisations. There was a need for collaborative cross-boundary working, as SGC works with other local authorities in their Sustainability and Transformation Partnership and Clinical Commissioning Group. Challenges included difficulties identifying SGC's priorities and population needs, data, staff training, and collaboration with academic researchers. They also reported resource issues exacerbated by COVID-19. Participants did not express conflicting views on these findings. InterpretationWe recommended the creation of a local authority research lead post working across Council directorates, local authority research networks, support for joint posts, increased accessibility and use of local authority data, cross-boundary research systems, and infrastructure to support research to respond to local authority needs. We also suggested increased funding and incentivisation for academics to engage with local authority research. Potential barriers to these recommendations include local authority funding and staff capacity challenges. This study was limited by its recruitment method, sample size, and data collection and analyses completed by a single researcher. Future research should explore what types of evidence local authorities consider most relevant and useful. FundingNIHR Public Health Research (grant number NIHR131952).

Feedback Loops and Facilitation: Catalyzing Transformational Multi-Stakeholder Refugee Response Partnerships

Global policies such as the recent ‘Comprehensive Refugee Response Framework’ call for a profound transformation in refugee response. To this end, collaboration with non-traditional humanitarian actors, particularly the private sector has been advocated. The application of new multi-stakeholder partnerships that transcend traditional dyadic relationships have been commended by practitioners for their ability to create stable services and markets in refugee camps. However, the adaptation of multi-stakeholder partnership models to the novelties of refugee response and the dynamics among partners in these complex arrangements requires more attention. This paper explores how the creation and development of multi-stakeholder partnerships can maximize the transformational potential of collaboration for refugee response, ensure the stakeholder diversity needed to provide basic services on a stable basis, and provide a facilitation function that supports the partnership. Using an action-case methodology, the focus of the article is on the Alianza Shire, Spain’s first multi-stakeholder partnership for humanitarian action, which was established to provide energy to refugee camps and host communities in refugee camps in northern Ethiopia. Our findings suggest that (i) the active participation of aid agencies in the co-creation process of a multi-stakeholder partnership may increase the transformational potential of refugee response, (ii) feedback loops and the consolidation of internal learning are essential practices for the effective management of complex multi-stakeholder partnerships, and (iii) the facilitator plays a critical and underexplored role in refugee response collaborative arrangements. In addition, sustainability-oriented university centers may possess a particular capacity for nurturing the transformational potential of multi-stakeholder refugee response partnerships by generating ‘safe spaces’ that foster trust-building, providing a cross-sector ‘translation’ service, and affording the legitimacy and expert knowledge required to conduct learning processes. We believe that the theoretical and practical implications of our research may contribute to the effective fulfilment of the Sustainable Development Goals, specially, SDG7 (Affordable and Clean Energy) and SDG17 (Partnership for the Goals).

A New Creativity Agenda, Part 2

HOW MIGHT WE SHAPE a New Creativity Agenda that offers a creativity lens for transformation? How might a creativity lens advance or accelerate regeneration aligned with Sustainable Development Goals (SDGs) of Agenda 2030? Drawing from art, science and technology, a creativity lens reveals new ways to see and reimagine systems, networks and ideas. This is the lens of Leonardo’s network of networks. Applied to SDGs, a Creativity Lens encourages ingenuity, cross-sector collaboration and innovative strategies needed to solve complex problems of sustainability.Modeled after the gender lens and sustainable investing movements, a Creativity Lens articulates new success factor criteria previously undervalued, overlooked, or overtly dismissed. Gender lens [1] asserts that gender-based issues of equity, equality, access and inclusion should be considered as investment priorities, often indicating more effective strategies across asset classes and industries. Sustainable investing [2], which considers environmental, social and governance (ESG) factors in investment strategies, now constitutes one-third of all U.S.-based assets under management [3]. A Creativity Lens would examine how SDG-focused or aligned activities from any sector incorporate hybrid, cross-cutting creative practices or perspectives.As the SDGs intend to provide a roadmap rather than a fixed course, a Creativity Lens can augment that roadmap with new routes, visualization, provocation, empathy, critical inquiry and beauty. A Creativity Lens is not merely a translation device to illustrate, communicate or popularize the Goals; it is a filter through which we better assess progress and design strategies for regeneration and sustainable development. Vibrant creative sectors and integrated art practices generate qualitative and quantifiable value correlated with key areas of the SDGs: healthy people, community and society, economic growth and development; increased social equity and access.Because SDGs are interconnected and interdependent, let’s consider clusters of goals together as they intersect with creativity introducing a relationship between the 2030 Agenda for SDGs and a New Creativity Agenda. Connecting creative practices to the SDGs lays the groundwork for a Creativity Lens.These Goals intersect with Creative Economy, creative industries, workforce development, the future of work, embedding creatives across all industries.Food, health, water are frequent themes attracting attention of bioart and ecoart movements. Public and community arts are vital to the health and well-being of individuals and communities.Social needs and justice are supported by democratizing arts, science and tech sectors. These goals are supported by radical access as creative practice, artistic freedom, free expression.These goals intersect with urban and industrial design, ecoart and circular economy innovation.Creatives continue to lead movements of ecoart and land art; bioart and biodiversity; Ocean MemoryWhile creativity intersects with all SDGs, “Partnerships” align most directly with Leonardo. Working together with creative individuals, institutions and industries across the Leosphere, Leonardo leads a transformational partnership platform [4]. Our creativity “network of networks” mobilizes breakthrough ideas to inspire and implement initiatives across all SDGs. Leonardo’s partnership platform serves to:

Partnering for UN SDG #17: a social marketing partnership model to scale up and accelerate change

Purpose The United Nations (UN) 17 Sustainable Development Goals (SDG) places partnerships as a vital mechanism, which strengthens the implementation of change strategies. The SDG targets are ambitious; acknowledging the interconnected multifaceted issues that are currently facing society. Similarly, social marketing thought is transitioning to embrace systemic change strategies, realising no one organisation can have an impact on the emerging grand challenges. Partnerships are the 5th P in the social marketing mix, however, partnerships is also a nebulous term which has been criticised for lacking theoretical development. This study aims to answer the call from both the UN and social marketing community for further research to guide the development and implementation of impactful transformative partnerships. Design/methodology/approach A robust mixed method approach to develop and test a social marketing partnership model is presented. Trust and relationship commitment are at the forefront of successful partnership exchanges. Morgan and Hunt’s (1994) trust and relationship commitment model is extended into the social marketing domain. Findings The findings validate Hasting’s (2003) call for social marketers to listen to their commercial marketing counterparts, positioning trust and commitment as essential to change strategies. As the degree of complexities in the multifaceted world continues to accelerate, partnerships for change (UN SDG #17) will pay off, driving more effective and smarter collaborations amongst a diverse range of stakeholders at different levels in different networks. Partnerships will elevate social marketing to deliver systemic transformation for complex problems with far reaching collective and sustainable consequences. Research limitations/implications With trust/mistrust critical to successful exchanges and exchange central to social marketing, quantitative measurement of the antecedents to and outcomes of partnerships can inform the evaluation, impact and management of social marketing interventions. Practical implications Three contributions are made, which support the selection, implementation and evaluation of social marketing partnerships. Key social marketing partnership characteristics are operationalised supporting the partnership selection process. Measurement scales are developed to assist in evaluating partnership relationships over time. The model is empirically tested to investigate the relationships between key mediating variables of social marketing partnerships. Originality/value This paper presents a validated 5th P Partnership model for social marketers, accelerating social marketing’s capacities to deliver systemic transformation for complex problems with far reaching collective and sustainable consequences and UN SDG #17.

A Healthier Future for Tissue Viability - An initiative to improve outcomes for patients with lower limb issues

Reducing unwarranted variation in clinical care and access to care was a central goal of the Five Year Forward View, and the later Long Term Plan. Variation in provision and access to lower limb services in one Sustainability and Transformation Partnership were apparent. Through networking and collaboration of STP wide tissue viability and related specialist services a programme of service development was accepted as part of wider Frailty service provision.This led to a public health needs assessment of the problem being commissioned; 6 clinical pathways being produced; and clear recommendations for improvement in service provision being made. The public health needs assessment is believed to be the first of its kind considering the issues of leg ulceration, cellulitis of the lower limb, lymphoedema of the lower limb (excluding cancer related), chronic oedema of the lower limb, diabetic foot ulceration and foot ulceration.Data from local hospital episode statistics, community services data and extrapolation from national data sources has been used to understand the local impact. This provided an idea of the numbers of the population affected, the costs to the local health economy and a baseline for improvement outcome measurement in the future. It also prompted widespread service provision changes to meet the needs of those living with lymphoedema and chronic oedema and pathways for skin tear and leg ulceration have been designed for implementation.The public health needs assessment is fully published and freely accessible elsewhere. This article describes the process followed to undertake the work.

The Staff Mental Health Service in Cambridgeshire and Peterborough: a new model for assessment and treatment of healthcare workers in the context of COVID-19 pandemic

AimsStaff mental health is a major determinant of a well-functioning health system that has become ever more important during the COVID-19 pandemic. Poor mental health is the most common reason for NHS staff sickness absences, usually accounting for 25% of all reported sick leave. At a time when the NHS most needs an available and efficient workforce, government and NHS employers lack the necessary evidence to inform decisions about how best to support the mental health needs of its staff. In this report, we share our experience and the initial figures from a newly developed multidisciplinary assessment and treatment service for NHS staff.MethodThe Staff Mental Health Service (SMHS) at the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) launched in September 2020. The SMHS is commissioned by the Cambridgeshire and Peterborough sustainability and transformation partnership and is accessible to the 25,513 staff based at five NHS trusts within the region. The service received 235 referrals within 5 months of the launch. All patients had a first clinical contact within three working days and more than 80% had their initial assessment within two weeks. The SMHS clinical team is comprised of consultant psychiatrists, senior clinical psychologists, specialist mental health nurses, and an occupational health nurse set to provide rapid access, confidential, evidence-based treatments for the NHS staff. As part of service evaluation within CPFT, we collected routine screening data (Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), and Posttraumatic Symptom Check List – 6 (PCL-6)) from patients completing the initial assessment (n = 130).ResultAccording to the initial figures (n = 130) from a diverse group of healthcare staff, on average the patients presented with moderate level of depressive symptoms (PHQ-9: 16.22 ± 5.94). Anxiety levels were in moderate to severe range (GAD-7: 13.45 ± 4.70). Average score of PCL-6 checklist for traumatic stress symptoms was higher than the established cut-off (>14): 19.43 ± 5.65.ConclusionThe Staff Mental Health Service offers an innovative, multi-disciplinary rapid assessment and treatment clinic for NHS staff. The demand for the service has been immense, reaching double the number of predicted referrals. Initial data suggested high rates of moderate to severe depression, anxiety, and traumatic stress symptoms in healthcare workers. Our clinical observations was that many healthcare workers have had longstanding significant mental health conditions that saw deterioration during the COVID-19 pandemic. We hope that our experience in the SMHS will help inform models across the UK to address the clear unmet need for staff mental health.

A Qualitative Analysis of the Commercial Broiler System, and the Links to Consumers' Nutrition and Health, and to Environmental Sustainability: A South African Case Study.

Food systems face growing challenges to meet targets of Zero Hunger (SDG 2), and South Africa is no exception given its triple burden of malnutrition, foodborne disease outbreaks, and threats of climate change to food production. Broiler meat is South Africa's most affordable meat option, supporting household food and nutrition security. Although considered healthier and less environmentally harmful than ruminant meat, it is not without food safety risks and environmental impacts. This research aimed to present the foremost commercial broiler system narratives in South Africa, around targets of SDG 2, and to discuss key considerations for policymakers. Twenty-nine key informants and stakeholders, purposively selected to cover a wide range of opinions, participated in semi-structured interviews. Transcripts underwent a qualitative framework analysis. Results showed a highly efficient system, dominated by a small number of interlinked large-scale actors, vulnerable to competition from cheaper imports, yet pressurized to maintain high food safety and environmental impact standards, with a price-sensitive consumer base. Existing policies lack integration and enforcement capacity, and are undermined by siloed government departments, and mistrust and power struggles between public and private sectors. We propose removal of silo walls, and trust building through participatory policy development, with collaborative and transformative public-private partnerships that are designed to build capacity to deliver sustainable solutions.