Growing old in England: economic and social issues

This paper examines the economic and social impact of changes in the duration of working life for the 80 per cent of older adults living in urban England. While some people are experiencing extended retirement because of moving out of paid work in their fifties, a growing minority of those beyond the state retirement age continue in paid employment. This paper highlights the considerable challenges for urban policy makers in addressing the economic and social inclusion of all older adults

Pylons in the back yard: local planning and perceived risks to health

Health fears arising from the presence of high-voltage power lines in residential areas have received recent attention in spatial planning. A study of stances taken by planning authorities in England and Wales shows their willingness to give expression to the concerns of local communities through precautionary measures, and the difficulties encountered in the face of official statements and industry opposition. These attempts to embody local feeling in patterns of development are illustrative of the increasing prevalence of a sense of risk in contemporary society. The spatial patterns of risk are also revealed, which owe much to the presence and distribution of industrial infrastructure in the landscape and to the associated contested use of land.</p

Harnessing Social Enterprise for Local Public Services

The government’s public service reform policy emphasises the collaboration of local authorities with a network of other agencies in the locality, either through contracts or through partnership arrangements. Strong encouragement is currently being given to the involvement of ‘third sector’ organizations (including social enterprises) in such partnering arrangements. This environment has opened up new opportunities for social enterprises. However, as the DTI has asserted in relation to social enterprise, ‘rhetoric rather than a robust evidence base continues to inform many arguments for its growth and support’ (DTI, 2003a: 49). This paper examines one of the most widespread examples of social enterprise in the provision of public services: ‘new leisure trusts’. It asks whether the combination of entrepreneurial skills and social purpose in social enterprises such as new leisure trusts provides a useful model upon which public service partnerships could be based. Findings show that these social enterprises can work to create synergy through improved input/output ratios, commitment to meeting social objectives and wider stakeholder involvement. However, there are issues of incentivisation and relative autonomy that must be resolved within such partnerships, and more work to be done in some cases to build genuine social inclusion

Moving around the city: discourses on walking and cycling in English urban areas

There remains only limited understanding of perceptions of travel behaviour in relation to short journeys in urban areas, and in particular, the perceived role that walking and cycling for personal travel can realistically play in contemporary society. This paper reveals discourses surrounding the practice, performance, identity, conflicts and visions relating to walking and cycling in English cities. These were derived from a large-scale study that utilized a comprehensive mixed-method approach using both quantitative and qualitative methods. Q Methodology was used as an additional tool to investigate subjectivities on walking and cycling in the city in a structured interpretable format and it is this approach that is the focus of this paper. The article concludes with a discussion on the implications of these discourses for policy makers interested in encouraging a shift from car use to walking and cycling for short journeys in urban areas

Area-based urban interventions: rationale and outcomes: the new deal for communities programme in England

It is now 40 years since the first area-based initiative (ABI) was launched in England. New Deal for Communities (NDC), announced in 1998, is one of the most ambitious of English ABIs in that it aims, over a period of 10 years, to reduce the gaps between 39 deprived areas and national standards in five outcome areas: crime, education, health, worklessness, and housing and the physical environment. Change data from the 2001-05 national evaluation are used to explore three considerations: change across the programme; drivers of mobility; and change at the partnership level. Barriers operating at the neighbourhood, city-wide and national levels have impacted on the implementation of the programme.</p

UK Health action zones: political accountability and political marketing - perspectives from the South West

This article evaluates the accountability of the strategic layer of Plymouth Health Action Zone (HAZ) and identifies conclusions with a wider application to partnership governance. The structures of Plymouth HAZ are assessed in the context of horizontal, vertical and downward models of accountability. The study finds fundamental weaknesses in the accountability regime. Vertical mechanisms are superficial and often inappropriate. The impact of horizontal accountability is marginalised through factors such as informal networks of dependency and a culture that discourages rigorous scrutiny. Downward accountability is addressed through the dissemination of information about achievements. In particular, the study highlights the difficulties of relying on local partners as the main mechanism of accountability. Plymouth HAZ is also evaluated in relation to political marketing and found to possess a sales-orientatio

The cost-effectiveness of the English smoking treatment services: evidence from practice

AIMS To investigate the cost-effectiveness of English specialist smoking cessation services. DESIGN Combination of observational cost and outcome data from English smoking cessation services to calculate cost-effectiveness ratios. Multivariate analysis of factors influencing variation in services' cost-effectiveness. SETTING Fifty-eight of the 92 specialist smoking cessation services in England in 2000/01. METHODS Services' costs were estimated using survey data which described services' configurations, staffing, interventions delivered and development. Information on services' throughput and outcomes (as biochemically validated 4-week smoking cessation rates) were obtained from routine sources. With reference to relevant literature and assumptions about relapse and background cessation rates, 4-week cessation rates were converted first to 1-year rates. One-year cessation rates were adjusted to reflect the likely permanent smoking cessation rate attributable to service intervention and finally attributable life-years gained were calculated. A wide variety of sensitivity analyses was performed to test the robustness of the average cost-effectiveness ratio, calculated by combining the cost and life-year gained estimates, for all services. With additional data on deprivation levels in services' areas, ordinary least-squares regression techniques were used to investigate variations in individual services' costs per client and cost-effectiveness ratios. FINDINGS Using an up-to-date estimate for health gain accrued by stopping smoking, the average cost per life gained was £684 (95% CI 557–811), falling to £438 when savings in future health-care costs were counted. With the worst case assumptions, the estimate of cost-effectiveness rose to £2693 per life-year saved (£2293 including future health-care costs) and fell to £227 (£102) under the most favourable assumptions. Findings are comparable to previous published studies. The regression results suggest that different factors influence cost per client and the net cost per life-year saved, indicating that decision makers should be careful in setting performance targets for these services. CONCLUSIONS In 2000/01, English smoking cessation services provided cost-effective services operating well below the benchmark of £20 000 per quality-adjusted life-year saved (QALY) that is used by the National Institute for Clinical Excellence in the United Kingdom