Can a case lead approach deliver the "craft and graft" of integration?

Purpose: The aim of this study was to explore the experiences and outcomes for adults with complex needs over time, within and between two teams that delivered integrated care across different Councils' services. The teams' approach to integration included two key features: a “case lead” way of working and the team itself operating as a single point of access (SPA) for residents in given neighbourhoods with high deprivation. Design/methodology/approach: The study was designed as evaluation research located in the realist tradition. Two teams acted as a case study to provide an in-depth understanding of how the case lead approach and SPA delivered the craft and graft of integrated working in the teams. Mixed methods of data collection included residents' ratings of their quality of life on five domains in an outcome measure over a six-month period. Residents and staff working in the teams also participated in semi-structured interviews to explore their respective experiences and receiving and delivering integrated care. The costs of care delivery incurred by residents were calculated based on their demands on public services in the year leading up to the teams' intervention and the projected costs for one year following this. Findings: The relationship between team context, case leads' inputs and residents' outcomes was mediated through the managerial style in the integrated teams which enabled case leads to be creative and do things differently with residents. Case leads worked holistically to prevent residents being in crisis as well as giving practical help such as sorting debts and finances and supporting access to volunteering or further education. Residents rated their quality of life as significantly improved over a six-month period and significant savings in costs as result of the teams' support were projected. Originality/value: The study used a multi-evaluation realistic evaluation methodology to explore the relationship between team context, case leads' inputs and residents' outcomes in terms that integrated services across different District and County Council Departments

New housing association development and its potential to reduce concentrations of deprivation: An English case study

Social housing across Western Europe has become significantly more residualised as governments concentrate on helping vulnerable households. Many countries are trying to reduce the concentrations of deprivation by building for a wider range of households and tenures. In England this policy has two main strands: (i) including other tenures when regenerating areas originally built as mono-tenure social housing estates and (ii) introducing social rented and low cost homeownership into new private market developments through planning obligations. By examining where new social housing and low cost home ownership homes have been built and who moves into them, this paper examines whether these policies achieve social mix and reduce spatial concentrations of deprivation. The evidence suggests that new housing association development has enabled some vulnerable households to live in areas which are not deprived, while some better off households have moved into more deprived areas. But these trends have not been sufficient to stem increases in deprivation in the most deprived areas

Financial viability appraisals for site-specific planning decisions in England

In England, appraisals of the financial viability of development schemes have become an integral part of planning policy-making, initially in determining the amount of planning obligations that might be obtained via legal agreements (known as Section 106 agreements) and latterly as a basis for establishing charging schedules for the Community Infrastructure Levy (CIL). Local planning authorities set these policies on an area-wide basis but ultimately development proposals require consent on a site-by-site basis. It is at this site-specific level that issues of viability are hotly contested. This paper examines case documents, proofs of evidence and decisions from a sample of planning disputes in order to address major issues within development viability, the application of the models and the distribution of the development gain between the developer, landowner and community. The results have specific application to viability assessment in England and should impact on future policy and practice guidance in this field. They also have relevance to other countries that incorporate assessments of economic viability in their planning systems

Taking stock of neighbourhood planning in England 2011-2016

Neighbourhood planning (NP) as enabled by the 2011 Localism Act in England has precipitated a considerable literature discussing its potential, limitations and likely shortcomings referenced against government rhetoric and the reporting of initial experiences of the process. This paper provides an overview of the current literature on neighbourhood planning and sets out how it has been received and practised across England drawing on empirical evidence. The extent of take-up and the experience of those involved first five years of neighbourhood planning and to consider how community-led planning may be designed and used following operational principles of inclusivity, capacity-building and adding value

The problem of clothes drying in new homes in the UK

The current focus on air tight construction to minimise energy use in homes in the UK requires analysis of the behaviour of the occupants. The aim of this paper is to review current literature and explore the methods used to dry clothes, to assess current standards and reccomendation for the drying of laundry in new homes and the issues arising with increased moisture within the building envelope where there may be inadequate ventilation caused by impermeable design Design/methodology/approach: Literature is reviewed on new housing in the UK and as part of a wider study of behaviour questionnairres were delivered to occupants of a recently completed housing estate in the uk to ask the questions with regard to their laundry practice. Findings: There are inherent problems in drying laundry in new air tight homes. This case study identifies 95% of residents on a new estate own a tumble dryer and use either this high energy method for clothes drying or hang clothes internally within the property leading to higher energy use or potential mould growth. Research limitations/implications: Further research is required into how drying laundry impacts on internal air qaulity in new homes designed to be energy efficient Practical implications: The design of new houses needs to be considered to provide a shift in people's behaviour with regard to low energy clothes drying Social implications: Originality/value: Other research has focussed on tenants in social housing in properties of mixed ages. This is the first study which focusses specifically on new energy efficient housing for owner occupiers

Urban resilience:two diverging interpretations

This paper uses two diverging interpretations of resilience to review and assess current UK policies for urban resilience. Both developed in scientific studies, the first interpretation is based on a mechanistic model of systems that can recover their original state after shocks, and the second is based on an evolutionary model enabling adaptation to disturbances. The literature review demonstrates that at present urban resilience is predominantly associated with the former. By contrast, only few policies and studies are inspired by the latter, although this is better suited to analyse dynamics of urban adaptation and manage cities accordingly. The contribution of this paper to an understanding of urban resilience is therefore twofold. First, an identification of the long-term consequences on the built environment associated with each model is provided, with the mechanical model ultimately hindering adaptation. Second, some approaches to generate effective responses to environmental and societal change are identified. Ultimately, this paper emphasises that the idea of a resilient city is fit for this age characterised by uncertainty, albeit it requires the recognition within planning practice that urban adaptation cannot be attained with current methodologies, and that much can be learned from theories on the resilience of ecosystems.

Financial incentives for smoking cessation in pregnancy: a single-arm intervention study assessing cessation and gaming.

AIMS: Financial incentives were the single most effective intervention for smoking cessation in pregnancy in a recent Cochrane Review, but based on a few small trials in the United States using only 7-day point prevalence measures of cessation. This study estimates (a) prolonged cessation in an unselected population of English pregnant smokers who are offered financial incentives for quitting and (b) 'gaming', i.e. false reporting of smoking status to enter the scheme or gain an incentive. DESIGN: Single-arm intervention study SETTING: Antenatal clinic and community PARTICIPANTS: A total of 239 pregnant smokers enrolled into the financial incentive scheme, attending for maternity care at one hospital in an area of high deprivation in England over a 42-week period. MEASUREMENTS: Smoking cessation at delivery and 6 months postpartum, assessed using salivary cotinine; gaming assessed using urinary and salivary cotinine at enrolment, 28 and 36 weeks gestation, and 2 days and 6 months postpartum. FINDINGS: Thirty-nine per cent (239 of 615) of smokers were enrolled into the scheme, 60% (143 of 239) of whom made a quit attempt. Of those enrolled, 20% [48 of 239; 95% confidence interval (CI) = 14.9%, 25.1%] were quit at delivery and 10% (25 of 239; 95% CI = 6.2%, 13.8%) at 6 months postpartum. There was no evidence that women gamed to enter the scheme, but evidence that 4% (10 of 239) of those enrolled gamed on one or more occasions to gain vouchers. CONCLUSIONS: Enrolment on an incentive scheme in an unselected English cohort of pregnant smokers was associated with prolonged cessation rates comparable to those reported in US trials. Rates of gaming were arguably insufficiently high to invalidate the use of such schemes.The scheme was funded by NHS Derbyshire County Primary Care Trust/Derbyshire County Council (from 1st 10 April 2013) Evaluation of the scheme was funded by the Wellcome Trust as part of a Strategic Award in Biomedical Ethics; program title: "The Centre for the Study of Incentives in Health"; grant number: 086031/Z/08/Z; PI Prof. TM Marteau. 086031/Z/08/Z).This is the final version of the article. It was first published by Wiley at http://onlinelibrary.wiley.com/doi/10.1111/add.12817/abstrac

Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

Background: The wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning. Methods: We conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas. Results: Public health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint. Conclusions: Our findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes and reduced health inequalities, but many of the opportunities brought about by the reforms are threatened by the continued flux in the system

Development viability assessment and the provision of affordable housing. A game of “pass the parcel”?

This paper constructs a hypothetical case study based around the Benchmark Land Value assessments within the landmark Parkhurst Road, London case decided in the High Court in April 2018. It attempts to illustrate how developers were gaming the system and how the 2014 Planning Practice Guidance aided them to do that. The discussion centres on the extent to which new 2018 National Planning Guidance has addressed the identified flaws and what additional changes might be needed to that guidance to solve any outstanding problems