The social geography of childcare: 'making up' the middle class child

Childcare is a condensate of disparate social forces and social processes. It is gendered and classed. It is subject to an excess of policy and political discourse. It is increasingly a focus for commercial exploitation. This is a paper reporting on work in progress in an ESRC funded research project (R000239232) on the choice and provision of pre-school childcare by middle class (service class) families in two contrasting London locations. Drawing on recent work in class analysis the paper examines the relationships between childcare choice, middle class fractions and locality. It suggests that on the evidence of the findings to date, there is some evidence of systematic differences between fractions in terms of values, perspectives and preferences for childcare, but a more powerful case for intra-class similarities, particularly when it comes to putting preferences into practice in the 'making up of a middle class child' through care and education

Are Labour Markets Necessarily Local? Spatiality, Segmentation and Scale

This paper draws on recent debates about scale to approach the geography of labour markets from a dynamic perspective sensitive to the spatiality and scale of labour market restructuring. Its exploration of labour market reconfigurations after the collapse of a major firm (Ansett Airlines) raises questions about geography’s faith in the inherently ‘local’ constitution of labour markets. Through an examination of the job reallocation process after redundancy, the paper suggests that multiple labour markets use and articulate scale in different ways. It argues that labour market rescaling processes are enacted at the critical moment of recruitment, where social networks, personal aspirations and employer preferences combine to shape workers’ destinations

Pathways of patients with chronic haematological malignancies: a report from the UK’s population-based HMRN

\ua9 2024 Roman et al. Background: Arising in blood and lymph-forming tissues, haematological malignancies (leukaemias, lymphomas and myelomas) are the fifth most common group of cancers. Around 60% are currently incurable and follow a chronic, remitting–relapsing pathway often initially managed by ‘watch & wait’. This involves hospital-based monitoring, followed by treatment if the cancer progresses (which not all do) and then further observation, in a process that may continually repeat. New treatments are constantly emerging, survival is improving and prevalence is rising, but population-based data documenting entire care pathway are sparse. Hence, empirically-based incidence and prevalence estimates about various treatment states (watch and wait, first-line treatment, observation, second-line treatment, etc.) and patterns of healthcare activity are lacking. Likewise, despite complex trajectories, anxiety-provoking watch and wait, and therapies that impede quality of life and incur marked healthcare costs, evidence about patient preferences for information sharing and treatment decisions is scant. Objectives: Primary – to generate high-quality, evidence-based information about the care pathways of the general population of patients with chronic haematological malignancies. Secondary – to produce information resources suitable for testing in routine National Health Service practice. Design: Population-based cohort of ≈ 8000 patients with chronic haematological malignancies, incorporating five nested work packages, each with its own individual design: (1) exploration of patient experiences: information and treatment decisions; (2) population-based analyses; (3) health economics; (4) development of information resources to support decision-making; and (5) patient well-being and decision-making survey. Setting: This programme is predicated on the infrastructure of the United Kingdom’s Haematological Malignancy Research Network (www.hmrn.org); which provides ‘real-world’, robust, generalisable data to inform research and clinical practice, nationally and internationally. Set in Yorkshire and Humberside, the Haematological Malignancy Research Network’s catchment population of ≈ 4 million has a comparable sex, age, urban/rural, and area-based deprivation (Index of Multiple Deprivation, income domain) distribution to the United Kingdom as a whole; and in terms of ethnic diversity the region is centrally ranked, with around 80% of residents identifying as White British, 9% as Asian and 2% as black. Within the Haematological Malignancy Research Network, clinical practice adheres to national guidelines, and all patients with blood cancers are centrally diagnosed (≈ 2500 each year), tracked through their treatment pathways and linked to national databases (deaths, cancer registrations and Hospital Episode Statistics). Linked to the same national databases, the Haematological Malignancy Research Network also contains an age-and sex-matched general-population cohort. Participants: Patients aged ≥ 18 years, resident in the study region, and diagnosed with chronic lymphocytic leukaemia, follicular lymphoma or myeloma. Methods: Core Haematological Malignancy Research Network data were used to compare the hospital activity of patients with chronic lymphocytic leukaemia, follicular lymphoma and myeloma with that of the general population. Following additional linkages to genetic and clinical data, follicular lymphoma prognostic factors were examined. Two self-administered questionnaires addressing (1) quality of life and well-being and (2) decision-making were iteratively developed, piloted and deployed. Linkage to quality of life, clinical information and Hospital Episode Statistics enabled economic (myeloma) model development. In-depth interviews were conducted with 35 patients (10 alongside relatives). Results: Trajectories of ≈ 8000 patients were mapped, and patient-pathway visualisations summarising individual and aggregate information were developed. As expected, patients with chronic blood cancers experienced higher levels of hospital activity than their general population counterparts, the largest effects being for myeloma. Following survey deployment, 3153 patients were recruited across 14 hospitals, 1282 with chronic lymphocytic leukaemia, follicular lymphoma or myeloma. Over half of the questionnaires were completed by patients on watch and wait; the remainder were completed during treatment or post-chemotherapy monitoring. Information gathered, coupled with in-depth interviews, demonstrated patients’ marked anxiety and fluctuating preferences for information sharing and decision-making, contingent on complex, inter-related factors. In turn, prognostic and microsimulation economic models were used to predict individual-level trajectories across multiple treatment lines, examining associated overall survival, costs and quality-adjusted life-years. Limitations: Survey mapping to individual care pathways could not be completed because the COVID-19 pandemic delayed clinical data collection. Patients who attended clinics and participated in the survey were more likely than non-attenders to have had first-line chemotherapy, be slightly younger and live in more affluent areas. Conclusions: This programme collated high-quality, population-based evidence. Previously lacking, this, coupled with new findings on preferences for information sharing and treatment decisions, provides the foundation for future research. Future work: The translation of information accrued into resources suitable for testing in routine NHS practice is key. In this regard, COVID-19 has changed the communication landscape. The visualisations developed by this programme require further refinement/testing using participatory co-design with stakeholder groups. Underpinned by a suitable protocol applied within a single multidisciplinary team setting, prior to further evaluation within/outside the region, such outputs require testing in a cluster-randomised trial

Manageable creativity

This article notes a perception in mainstream management theory and practice that creativity has shifted from being disruptive or destructive to 'manageable'. This concept of manageable creativity in business is reflected in a similar rhetoric in cultural policy, especially towards the creative industries. The article argues that the idea of 'manageable creativity' can be traced back to a 'heroic' and a 'structural' model of creativity. It is argued that the 'heroic' model of creativity is being subsumed within a 'structural' model which emphasises the systems and infrastructure around individual creativity rather than focusing on raw talent and pure content. Yet this structured approach carries problems of its own, in particular a tendency to overlook the unpredictability of creative processes, people and products. Ironically, it may be that some confusion in our policies towards creativity is inevitable, reflecting the paradoxes and transitions which characterise the creative process

The difference that tenure makes

This paper argues that housing tenures cannot be reduced to either production relations or consumption relations. Instead, they need to be understood as modes of housing distribution, and as having complex and dynamic relations with social classes. Building on a critique of both the productionist and the consumptionist literature, as well as of formalist accounts of the relations between tenure and class, the paper attempts to lay the foundations for a new theory of housing tenure. In order to do this, a new theory of class is articulated, which is then used to throw new light on the nature of class-tenure relations

Young British Pakistani Muslim women’s involvement in higher education

YesThis article explores the implications for identity through presenting a detailed analysis of how three British Pakistani women narrated their involvement in higher education. The increased participation of British South Asian women in higher education has been hailed a major success story and is said to have enabled them to forge alternative, more empowering gender identities in comparison to previous generations. Drawing on generative narrative interviews conducted with three young women, we explore the under-researched area of Pakistani Muslim women in higher education. The central plotlines for their stories are respectively higher education as an escape from conforming to the ‘good Muslim woman’; becoming an educated mother; and Muslim women can ‘have it all’. Although the women narrated freedom to choose, their stories were complex. Through analysis of personal ‘I’ and social ‘We’ self-narration, we discuss the different ways in which they drew on agency and fashioned it within social and structural constraints of gender, class and religion. Thus higher education is a context that both enables and constrains negotiations of identity

Automatic transmission: ethnicity, racialization and the car

YesThis article is based on ethnographic research carried out in Bradford, an ethnically diverse city situated in the north of England. The sample of over 60 participants mostly comprises males of British Pakistani Muslim heritage but varies in terms other markers of identity such as social class, profession and residential/working locale. The article analyses the cultural value and meaning of cars within a multicultural context and how a consumer object can feed into the processes which refine and embed racialized identities. Small cases studies reveal the concrete and discursive ways through which ideas around identity and ethnicity are transmitted and how, in particular, racialization continues to feature as a live, active and recognisable process in everyday experience

Cohesion as ‘common sense’: Everyday narratives of community and cohesion in New Labour’s Britain

The final, definitive version of this paper has been published in Politics, Vol. 36(3) July 2016, DOI: 10.1177/0263395715620811 published by SAGE Publishing. All rights reservedThis article engages with popular narratives of community and cohesion, explored through a series of focus groups in Bradford and Birmingham. This article argues that the participants interviewed used discourses propagated by government to make sense of these narratives in their neighbourhoods and communities. The use of these discourses constructs what Gramsci calls a ‘common sense’ position, which legitimises a specific and targeted notion of cohesion. However, participants can contaminate these discourses, which can lead to subtle changes or explicit challenges to dominant discourses on community and cohesion in the United Kingdom.Peer reviewe

What are the cost-savings and health benefits of improving detection and management for six high cardiovascular risk conditions in England? An economic evaluation

Objectives To estimate the cost savings and health benefits of improving detection of individuals at high risk of cardiovascular disease (CVD) in England, to determine to which patient subgroups these benefits arise, and to compare different strategies for subsequent management. Design An economic analysis using the School for Public Health Research CVD Prevention Model. Setting England 2018. Participants Adults aged 16 and older with one or more high cardiovascular risk conditions, including hypertension, diabetes, non-diabetic hyperglycaemia, atrial fibrillation, chronic kidney disease and high cholesterol. Interventions Detection of 100% of individuals with CVD high risk conditions compared with current levels of detection in England. Detected individuals are assumed to be managed either according to current levels of care or National Institute of Health and Care Excellence (NICE) guidelines. Main outcome measures Incremental and cumulative costs, savings, quality adjusted life years (QALYs), CVD cases, and net monetary benefit, from a UK NHS and Personal Social Services perspective. Results £68 billion could be saved, 4.9 million QALYs gained and 3.4 million cases of CVD prevented over 25 years if all individuals in England with the six CVD high risk conditions were diagnosed and subsequently managed at current levels. Additionally, if all detected individuals were managed according to NICE guidelines, total savings would be £61 billion, 8.1 million QALYs would be gained and 5.2 million CVD cases prevented. Most benefits come from detection of high cholesterol in the short term and diabetes in the long term. Conclusions Substantial cost savings and health benefits would accrue if all individuals with conditions that increase CVD risk could be diagnosed, with detection of undiagnosed diabetes producing greatest benefits. Ensuring all conditions are managed according to NICE guidelines would further increase health benefits. Projected cost-savings could be invested in developing acceptable and cost-effective solutions for improving detection and management