Clinical peripherality: development of a peripherality index for rural health services

BACKGROUND: The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. METHODS: Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. RESULTS: Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. CONCLUSION: Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may assist planners in conceptualising the effects on general practices of centralising specialist clinical services or administrative and educational facilities

Elected Mayors: Leading Locally?

The directly elected executive mayor was introduced to England a decade ago. Drawing inspiration from European and American experience, the elected mayor appealed to both New Labour and Conservative commentators in offering a solution to perceived problems of local leadership. There was a shared view that governance of local areas was failing and that elected mayors were the answer. The first local referendums were held in 2001. Most have continued to reject the idea of the elected mayor. During 2012, the coalition government initiated 10 further mayoral referendums in England's largest cities but only one, Bristol, opted for an elected mayor. Overall, there is no evidence of widespread public support, yet the prospect of more mayors - with enhanced powers - remains firmly on the policy agenda. Drawing from a decade of research, this paper considers reasons for the persistence of the mayoral experiment, the importance of local factors in the few areas where mayors hold office and the link to current policy debates. Using the authors' analytical leadership grid, this paper links the governmental, governance and allegiance roles of mayors to the problematic nature of local leadership. It then draws tentative conclusions about the strange case of the elected mayor in England

Regional polycentricity: an indicator framework for assessing cohesion impacts of railway infrastructures

Territorial cohesion has become one of the main objectives in transport planning. This has fostered the development of assessment methodologies to quantitatively estimate the territorial impact of major transport infrastructures, which are particularly scarce at the intra-regional level. Linked to cohesion, polycentricity has been defined as the best spatial configuration to achieve balanced regions where population and opportunities are distributed among several entities linked by functional relationships. This paper aims to present a methodology to estimate these impacts based on the use of a new regional composite polycentricity indicator. The proposed indicator is tested by comparing the effects of conventional and high-speed railway (HSR) alternatives in the territorial system of a northern region of Spain. This quantitative assessment is a ranking tool for prioritizing rail network alternatives in terms of achieving the most balanced territory, which is especially relevant in countries where HSR networks follow cohesion goals. Our results show that new HSR links should only be complementary to regional railway services, and that the suppression of secondary lines should be avoided if a reduction in polarization is to be achieved.E. González-González gratefully acknowledges a predoctoral fellowship (FPI) from the Spanish Ministry of Science and Innovation (reference BES-2008–00436)

Exploring Territorial Imbalances: A Systematic Literature Review of Meanings and Terms

Within the framework of the EU Strategies of Territorial Cohesion, a relevant role is played by policy design focused on a more balanced and equal development of regions pursued by regenerating and improving endogenous resources. A place-sensitive instead of place-neutral approach can be useful to overcome weaknesses, innovation gaps and social-economic issues related to asymmetric and unequal development between and within regions. This paper deals with the complexity of territorial imbalances and spatial inequalities by focusing on lacking, declining and marginal areas. By developing a Systematic Literature Review, a first mapping of terms, practices and issues related to those areas has been developed in order to investigate scenarios in different geo-political contexts and at various spatial scales. The Systematic Literature Review approach has permitted the systematization of a multitude of terms referring to gaps between core areas and areas suffering from territorial imbalances, as well as the exploration of disciplinary sectors, geographical contexts, document typologies, frequency of terms, and to develop a preliminary geo-localization of practices. The findings of this first step are relevant to providing a systematic knowledge base within a complex field in which a clarification of meanings, scales and processes is needed

Participatory-deliberative processes and public policy agendas:Lessons for policy and practice

open access journalParticipatory and deliberative processes have proliferated over recent decades in public administration. These seek to increase the effectiveness and democratic quality of policy making by involving citizens in policy. However, these have mainly operated at local levels of governance, and democratic theorists and practitioners have developed an ambition to scale these up in order to democratize higher tiers of government. This paper draws policy lessons from research on a “multi-level” process that held a similar ambition. The Sustainable Communities Act sought to integrate the results of various locally organized citizen deliberations within the policy development processes of central UK government. In doing so, it aimed to democratize central government problem definition and agenda-setting processes. The paper distinguishes between achievements and failures explained by process design, and more fundamental obstacles to do with broader contextual factors. As such, it identifies lessons for the amelioration of design features, while recognizing constraints that are often beyond the agency of local practitioners. The findings offer practical insights for policy workers and democratic reformers seeking to institutionalize participatory and deliberative innovations

The geo-constitution: Understanding the intersection of geography and political institutions

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this record.This paper draws on existing work in the discipline of human geography and cognate fields in order to develop the concept of the ‘geo-constitution’. This concept aims to: (1) highlight the importance of intersections between geography and political institutions in the constitution of government; (2) consider the path-dependent development of political institutions and their impact on statecraft and citizenship; (3) explore the implications of this for political reform. The paper provides an overview of current thinking in political geography and applies the concept of the geo-constitution to the example of devolution and localism in the United Kingdom

Taxonomy based on science is necessary for global conservation

Peer reviewe

Multiscalarity and neighbourhood governance

Multiscalarity and neighbourhood governanc