United Kingdom Context Research Articles

The medical doctor (degree) apprenticeship

In this article we explore the United Kingdom context of apprenticeships and the history of development of the use of the term apprentice in medicine. We describe the development of the Medical Doctor Degree Apprenticeship (MDDA) in England and how Anglia Ruskin University (ARU) has approached the development of the MDDA. We explore the rationale for developing the MDDA in Essex, the structure of the apprenticeship at ARU (which comprises 20% of employed time in NHS work and 80% in education undertaking the medical degree), the challenges and issues we encountered and mitigations we put in place. We describe the importance of stakeholder engagement (especially with direct entry medical students, medical professionals, and members of the university staff). The role of the employer is critical to the development and delivery of MDDA. The important role of regulators in developing and monitoring MDDA is the complexity of funding arrangements. Finally, we offer reflections on the development journey thus far.

‘This is not a drill’: Police and partnership preparedness for consequences of the climate crisis

This scoping study investigates the state of preparedness of the police and their partners for the potential consequences of the climate crisis in a United Kingdom (UK) context. The research engaged participants at strategic, tactical and operational levels of planning and operations, and conducted a thematic analysis of qualitative data to identify key themes: climate change impacts; why the police should care; prioritisation and preparation; and enabling and impeding factors. The results suggest that the police and their partners may be ill-prepared for the gamut of possible consequences. Preparedness appears hampered by a narrow focus on legislated requirements, short-term planning, lack of funding and resources, and limited prescience. Recommendations are made for redefining planning parameters, strengthening central government engagement, amplifying awareness and understanding of trend analyses, prioritisation of ‘futures’ thinking, ethical considerations and collaborative preparedness. The study has implications for law, public policy and professional practice in the UK, and other global jurisdictions seeking to develop risk assessment processes and preparedness for the consequences of climate change.

Standards of proficiency for registered nurses-To what end? A critical analysis of contemporary mental health nursing within the United Kingdom context.

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of 'proficiency' in nurse education-prescribed by the regulator-impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical-legal challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self-determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtfuland confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogyand assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain.

'Moving on' for Adults With a Learning Disability and Their Families: A Constructivist Grounded Theory Study.

Ending familial co-residence, termed 'moving on' by participants, is an increasingly relevant life transition for people with a learning disability due to increasing life expectancy and policy developments. Nevertheless, there is an absence of research exploring this transition experience in a United Kingdom (UK) context. This constructivist grounded theory study therefore aimed to explore, conceptualise, and theorise the 'moving on' experiences of adults with a learning disability and their families. This article reports the experiences of five adults with a learning disability and nine family members in England, UK. Narrative interviews and creative storybook methods were used to collect data between April 2015 and May 2016. Constant comparative methods, theoretical sampling, and memo writing were used throughout data collection and analysis. Participants with a learning disability presented personal growth and greater life fulfilment over the course of the transition; they flourished. In parallel, family members relinquished their care responsibilities. Importantly, the iterative and reciprocal relationship between flourishing and relinquishing shows that ongoing family member involvement is crucial during and following relocation. Family members identified factors that potentially inhibit relinquishing: pressure to 'let go', different perceptions of independence between family members and service providers, inadequate future investment, and rapport with professional carers. These novel insights led to the generation of the first known mid-range theory concerning this transition, entitled 'Moving on: flourishing and relinquishing'. Findings will guide future research in this field and facilitate the design of appropriate support for people with a learning disability and their families.

Implementation of the polluter pay’s principle in tobacco control in the UK: a stakeholder analysis

BackgroundThe polluter’s pay principle (PPP) aims to internalise external costs and assign liability to the polluter for the harmful cost of their products to society. Tobacco companies continue to manufacture and sell harmful cigarettes, earning billions in profits each year from these products. Meanwhile, governments and their people are left to ‘clean up’ and deal with the detrimental health consequences. This paper explores with expert stakeholders how the PPP could be implemented within the context of tobacco control in the United Kingdom (UK).MethodsTwenty-four semi-structured interviews and two follow-up discussion groups were conducted with UK and international experts on tobacco control, public health, economics, or law from the academic, public, private and third sector. Participants considered the facilitators and barriers to implementing the PPP to tobacco control in the UK. Thematic analysis was employed, aided by NVivo 12, and data were compared to examine the views expressed by the different types of experts.ResultsStakeholders favoured the implementation of the PPP in the context of tobacco control and indicated that it could be acceptable and feasible to implement and that it would likely have support from policymakers and the public alike. Stakeholders unanimously agreed that any legislation and administration should be free from tobacco industry influence; however, differences arose concerning who should oversee the implementation.ConclusionThe PPP from environmental law was predominantly seen as an approach that could be usefully applied to the tobacco industry. However, there is no one size fits all template, therefore its implementation would need to be adapted to fit the UK context.

Students' perceptions of a UK physiotherapy student-led clinic.

Student-led clinics (SLCs) are a mode of delivery whereby students take responsibility for the delivery of a health service or intervention. SLCs for physiotherapy have a wide range of uses, including enhancement of learning, replacement of clinical placement hours and serving population and community needs. Evidence is emerging globally as to the outcomes of SLCs in physiotherapy, but little exists in the United Kingdom (UK) context. The purpose of this study was to explore student perceptions of running, leading and participating in a UK physiotherapy student-led neurological rehabilitation clinic. A qualitative design using a focus group. Four themes were identified relating to students' perceptions of SLCs associated with the learning environment, self-development, enhanced clinical skill development and reflections on experience at the SLC. The findings of this study suggest that physiotherapy SLCs in a UK context can contribute positively to student experience and skill development, particularly in relation to the learning environment, development of clinical skills, leadership and autonomy. Some aspects related to, for example, student induction and preparation could be further developed. Further research should explore if these findings are applicable in other countries where SLCs are less established. Further research in the UK and globally related to SLC models in different courses and across varying stages is required. Exploration of the SLC as a viable form of clinical placement experience is also warranted.

Neo-Islamophobia: A New Western Social Order

Traditionally, the term Islamophobia refers to prejudice, racism, and/or securitization which implies that this phenomenon operates at cognitive, cultural, or structural levels. The current researchers anticipate that the term now represents an Islamophobic social order in the West where hatred for Islam and everything related to it appears to be the collective behaviour of the society. This points to a new social reality that goes beyond the psychological problem, now referred to as Islamophobia. Therefore, the researchers have added the prefix "neo" to this term in order to account for Islamophobia's psychosocial nature which manifests itself in discourses and practices. The purpose of this research is to study Islamophobic discourses in the media of two Western societies in order to better understand the nature of Islamophobia in each: the United Kingdom (UK) and the United States (USA). It studies leading articles (that is, 446 in toto) from The Independent and The Washington Post between November 2016 and December 2017, using DHA's analytical framework. This study concludes that traditional "Islamophobia" dominates in the UK context, where Islam is perceived as a threat to Europe's symbolic identity and "Neo-Islamophobia" in the US context, where Islam is seen as a threat to the socio-political order. It also proposes a cyclical process of neo-Islamophobia, beginning with problematizing Islam, and progressing to “otherizing,” racializing, and finally securitizing Muslims. The researchers, however, recommend similar studies in other contexts too.

Remote Work, Work Measurement and the State of Work Research in Human-Centred Computing

Abstract Over the past few decades, a small but growing group of people have worked remotely from their homes. With the arrival of the coronavirus pandemic, millions of people found themselves joining this group overnight. In this position paper, we examine the kinds of work that ‘went remote’ in response to the pandemic, and consider the ways in which this transition was influenced by (and in turn came to influence) contemporary trends in digital workplace measurement and evaluation. We see that employers appeared reluctant to let certain classes of employee work remotely. When the pandemic forced staff home, employers compensated by turning to digital surveillance tools, even though, as we argue, these tools seem unable to overcome the significant conceptual barriers to understanding how people are working. We also observed that, in the United Kingdom context, the pandemic didn’t mean remote work for a significant proportion of the population. We assert that, to maximize its impact, ‘future of work’ research in human-centred computing must be more inclusive and representative of work, rather than focusing on the experiences of knowledge workers and those involved in new forms of work.

Psychiatric advance directives (Ulysses Contract): the need for a specific law and a criteria proposal for its introduction.

Advance healthcare directives in the psychiatric field raise more concerns and controversies compared to their use in other medical branches. We discuss the role of advance directives in this field and suggest a criteria proposal for the settlement of a comprehensive regulation on the matter. We analyse the existing law and discuss the ethical points in the Italian context and, in comparison, with the United Kingdom context. Numerous studies have highlighted that psychiatric patients experience advance directives as an instrument to participate in therapeutic decision-making. Regarding the usefulness of advance directives, Italy and the United Kingdom did not approve deontological rules or laws. The United Nations Commission states that, based on the principles of the Convention on the Rights of Persons with Disabilities, it is necessary to respect the spatient's will, even if it is biased by psychic disorders. The Convention does not consider advance directives; instead, they just suggest using some support to have the patient regain their competence. In case this is unsuccessful, it is necessary to appoint a substitute decision-maker to express, even in the light of the advance directives, the will that the patient would have expressed if he had been competent.

Faces of hunger: an intersectional approach to children's right to food in the United Kingdom

AbstractThis article explores the extent to which the right to food is currently enjoyed by children within the United Kingdom (UK) using image analysis of the food parcels received by children eligible for free school meals during the COVID‐19 pandemic. It argues that child food poverty serves as an illustration of the failings of neoliberalism in the UK context, which had already been observed prior to the pandemic in relation to the current Universal Credit system. The article adopts an intersectional approach, connecting the increased risk of food insecurity experienced by Black, Asian, and minority ethnic (BAME) children from low‐income backgrounds to the broader notions of racial capitalism and food oppression. It concludes by offering proposals to target inequalities and improve the realization of the right to food for all children in the UK, which could be adopted by other states to enhance the protection of children's right to food around the globe.

Brits and British Muslims and their perceptions of cultured meat: How big is their willingness to purchase?

AbstractConsumer preferences regarding food in general, livestock meat and cultured meat among Muslim populations remains largely unknown, especially in a United Kingdom context. This is a significant gap in our understanding since foods that meet halal requirements have a major economical share of both the British and the global food market. The aim of this study is threefold: (1) gain insight into the perceptions of the broader British community and the Muslim demographic within it regarding food choice determinants, livestock meat, and cultured meat; (2) investigating similarities and differences within and between the two groups; and (3) model the willingness to purchase (WTPu) cultured meat for both populations. The British Muslim and the British non‐Muslim population are very similar in their considerations about food in general, livestock meat and cultured meat. With regard to the willingness to purchase cultured meat, further product development and marketing strategies should focus on the same factor for both populations: the healthiness, safety, and nutritional characteristics of cultured meat.

Managing medicines at the end of life: a position paper for health policy and practice.

The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care. Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities. Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent "revolution" in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered. The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery.

Status, relative deprivation, and moral devaluation of immigrants.

Immigration has been a prominent political issue for decades, but particularly so with rising national populism. To understand current anti-immigration opinion, we turn to the concept of relative deprivation, which, we argue, is fundamentally about entitlement and is at the heart of popular backlash against immigration. Examining the United Kingdom context, we predicted that immigration attitudes would be contingent on immigrant group status, with immigrants from low-status or poorer countries (Poland, India) more likely to be perceived as encroaching on the majority group's entitlements than those from high-status or richer countries (Germany, Australia). We further proposed moral devaluation (dehumanization and distrust) as a novel mechanism (over and above prejudice) underlying the conditional effects of relative deprivation on support for formal (anti-immigration policies) and informal (hate crime) means of immigrant exclusion. A pilot study (n = 245) and cross-sectional survey (n = 490) results supported our main prediction that status matters: participants felt more deprived relative to low- than high-status immigrants, and this predicted stronger support for anti-immigration policies both directly and through higher distrust (but not dehumanization). This research highlights the need to unpack the generic 'immigrant' category and study anti-immigration sentiment in terms of group status and moral devaluation.

The Lived Experience of Inequalities in the Provision of Treatment for Hepatitis C.

The issues of health, illness, stigma and inequalities in healthcare provision, areas that in my role as a social researcher were already of interest and concern, shifted to a different perspective when I was diagnosed with hepatitis C. From this altered position, my body and lifeworld were a nexus point for a range of ongoing challenges around staying as well as possible, and the struggle to get my healthcare needs met. There is a gap between the support provided for some ill and disabled people, and the help that they actually require. This is particularly so for conditions that are not well understood, that have a low public profile, limited funding, and/or are in some way stigmatised due to perceived differences to social norms. Hepatitis C is one such condition, it is a viral disease that is transmitted through blood-to-blood contact and it causes ongoing damage to the liver. Because of the systemic nature of the disease, individuals may struggle to cope with the demands of work and daily living, and their lifeworld and opportunities are frequently limited. It can be challenging for the patient to advocate for themselves due to low energy levels, self-blame for getting ill, and the stigma associated with the condition. The first generation of effective anti-viral drugs emerged from clinical trials in 2013, but in the United Kingdom context, access was only possible for those with advanced liver disease. Therefore, many patients felt compelled to purchase the anti-virals through Buyers Clubs, whereby generic versions of the drugs are imported for personal use at a fraction of the market cost. In this article I draw on my own lived experience of joining a Buyers Club as an example of how risks and benefits are weighed, and to explain the contexts in which decisions are shaped and made.

Call of interprofessional duty: an ethnographically informed discussion on preparing students to be digitally resilient

ABSTRACT What role does social media play for interprofessional education in a pandemic? This is the first pandemic to occur in a world filled with social media, where digital communication is ubiquitous and a high percentage of those affected are digitally literate. This paper situated within a United Kingdom (UK) context explores this new phenomenon, discussing the ways in which digital gift giving toward health and social care professionals has developed on a variety of social media platforms. This discussion proposes a theoretical understanding of digital gift giving and raises the importance of digital resilience for interprofessional learning and working. Reflections are made on the expected and imagined reciprocity of digital gift giving and the talismanic nature of employing symbols digitally to ward off COVID-19. This paper employs an ethnographic lens to unpack the issue of digital gift giving and recommends preparing students for the onslaught of digital gifts they may be exposed to upon entering the workplace. Academics are called on as the mediators of these recommendations, and suggestions are made as to how students can be best prepared for a digitally saturated interprofessional practice.

PMU35 MODELING POTENTIAL HEALTH GAINS AND HEALTH SYSTEM SAVINGS ASSOCIATED WITH VAPORIZED NICOTINE PRODUCTS IN CANADA

To model population-wide health and cost impacts of vaporized nicotine products (VNPs) for Canadian adults 20 years and older from 2015 onwards, with associated uncertainty. A multi-state life-table model including 14 tobacco-related (TR) diseases was used to model potential changes in life expectancy and health-system costs, overall and by province/territory, using a 0% discount rate. The simulated population was divided into 68 cohorts by gender, ethnicity, and age. Each year, individuals could either remain in their current state, or transition to one of six smoking/vaping states. Input data including smoking/vaping prevalence by state, transition matrices, and relative risks of TR diseases by smoking/vaping state were estimated using data from Statistics Canada and literature. For each TR disease, incidence, prevalence, and direct healthcare and indirect costs were calculated. Three scenarios were modeled to reflect a range of uncertainty: Status Quo (“SQ”, VNPs commercialized as they are currently in Canada); No-Vaping (“NV”, assuming VNPs never entered the Canadian market); and Liberalized (“LIB”, VNPs commercialized in a policy environment similar to the United Kingdom context). The model performed well against validation with publicly available data. Preliminary results indicate that compared to the NV scenario, the SQ scenario projected to decrease life-years lost due to TR diseases, while the LIB scenario would lower them further. The SQ scenario projected a C$55.5 billion reduction in cumulative lifetime costs (life-years lost due to TR diseases, incremental direct health-system and indirect productivity costs) compared to the NV scenario. Statistical variability was assessed using sensitivity analyses on input parameters and Monte-Carlo simulations. Accessibility to VNPs in Canada may generate net public-health gains and health-system cost savings. These projected health and economic consequences are sensitive to assumptions about accessibility and use by adult smokers, and may vary by type of policy environment.

Entitlements, Capabilities, and Crisis in the United Kingdom

This paper examines whether Amartya Sen’s entitlements and capabilities concepts can be transferred in their application from low-income countries to high-income countries, specifically Cumbria, Northern England. Originally used to understand the causes of famine, these concepts have previously been used in several different geographical contexts to broadly understand poverty and inequality but almost entirely in low-income countries. This paper applies these concepts to a United Kingdom context in an attempt to understand the causes of poverty and inequality among people experiencing “livelihood crisis.” The research uses data from two nongovernmental social welfare projects to examine the causes of crisis and the remedial effects of the intervention. Our findings indicate that these concepts can help to explain how people find themselves in crisis in Cumbria. On a broader level, they can also be used to explain poverty, inequality, and disadvantage in communities in the United Kingdom. The authors put forward that entitlements and capabilities provide a useful framework to advance the policy and political debate on the causes of poverty by providing a straightforward language and broad application. Entitlement and capabilities can also assist social welfare programs in framing their aims and objectives and through improved understanding about the causes of inequality, will be better able to support people out of disadvantage by strengthening entitlements and building capabilities, without the necessity of large-scale investment.

Editorial-How soon is soon enough? The challenge of implementing behaviours conducive to good oral health in at-risk infants and toddlers.

This commentary is about one of the last great challenges facing dental public health. It is a problem I will discuss in a United Kingdom context, but the issues will, I am sure, be of relevance to all readers of this Journal wherever they practice. It is a problem that I spent many hours trying to address when I was in the early stages of my career. Now, when I am nearer the end than the beginning, it is still a problem. The issue? Preventing dental decay in those aged under 3 years old, who in the main, reside in areas of social and economic disadvantage.

The biopolitics of the migration-development nexus: Governing migration in the UK

While politicians in the United Kingdom (UK) have engaged in fractious debate over the appropriate way of responding to the myriad issues arising from the so-called migration or refugee crisis in recent years, there is an apparent cross-party consensus regarding the ability of overseas aid and development spending to reduce levels of global economic migration. This suggests that the central tenets of what is known in the policy literature as the ‘migration-development nexus’ have been accepted by the political establishment in the UK, demonstrating a belief that development spending can be used to ameliorate the global economic inequalities seen as giving rise to mass migration. Drawing on Michel Foucault’s concepts of biopolitics, governmentality, and subjectification, this article argues that the migration-development nexus represents a technology for enacting a strategy of governance that operates through a dual process of enticing and maintaining mobile subjects. It is then suggested that in the UK context, this operates through the temporary nature of the time-limited visa regime, which allows migrants from outside the European Union to be ‘governed through mobility’. The article therefore illustrates how mobility can be central to governing logics, as well as something that can exceed them.

Clinical practice guidelines for older people with multimorbidity and life-limiting illness: what are the implications for deprescribing?

The aim of this study was (1) to apply the current United Kingdom (UK) National Institute for Health and Care Excellence (NICE) clinical practice guidelines to a hypothetical older patient with multimorbidity and life-limiting illness; (2) consider how treatment choices could be influenced by NICE guidance specifically related to multimorbidity; and, (3) ascertain if such clinical practice guidelines describe how and when medication should be reviewed, reduced and stopped. Based upon common long-term conditions in older people, a hypothetical older patient was constructed. Relevant NICE guidelines were applied to the hypothetical patient to determine what medication should be initiated in three treatment models: a new patient model, a treatment-resistant model, and a last-line model. Medication complexity for each model was assessed according to the medication regimen complexity index (MRCI). The majority of the guidelines recommended the initiation of medication in the hypothetical patient; if the initial treatment approach was unsuccessful, each guideline advocated the use of more medication, with the regimen becoming increasingly complex. In the new patient model, 4 separate medications (9 dosage units) would be initiated per day; for the treatment-resistant model, 6 separate medications (15 dosage units); and, for the last-line model, 11 separate medications (20 dosage units). None of the guidelines used for the hypothetical patient discussed approaches to stopping medication. In a UK context, disease-specific clinical practice guidelines routinely advocate the initiation of medication to manage long-term conditions, with medication regimens becoming increasingly complex through the different steps of care. There is often a lack of information regarding specific treatment recommendations for older people with life-limiting illness and multimorbidity. While guidelines frequently explain how and when a medication should be initiated, there is often no information concerning when and how the medications should be reduced or stopped.