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

2015 Statewide Bridge Sufficiency Rating Report - Full

The main purpose of this report is to provide bridge sufficiency rating information for the bridges in each county to county officials as a convenient starting point for formulating a long-range plan to cope with their county bridge deficiencies. This information results from the data generated by the national Bridge Inspection Standards (NBIS) program authorized by the 1968 Federal-Aid Highway Act

2012 Statewide Bridge Sufficiency Rating Report

The main purpose of this report is to provide bridge sufficiency rating information for the bridges in each county to county officials as a convenient starting point for formulating a long-range plan to cope with their county bridge deficiencies. This information results from the data generated by the national Bridge Inspection Standards (NBIS) program authorized by the 1968 Federal-Aid Highway Act

2015 Statewide Bridge Sufficiency Rating Report - Condensed

The main purpose of this report is to provide bridge sufficiency rating information for the bridges in each county to county officials as a convenient starting point for formulating a long-range plan to cope with their county bridge deficiencies. This information results from the data generated by the national Bridge Inspection Standards (NBIS) program authorized by the 1968 Federal-Aid Highway Act

Advancing our cities and regions strategy

The Advancing our cities and regions strategy is an innovative approach to renewing and repurposing surplus and underutilised state property to deliver better community outcomes, create jobs and drive economic growth. Property Queensland within the Department of State Development is working with government land-owning agencies to identify sites that represent property opportunities that will deliver on government priorities, and generate economic development and community outcomes. To help achieve this strategy, eight economic and community zones have been identified where Economic Development Queensland (EDQ) will lead the delivery of a range of projects, many of which will be iconic developments to transform precincts and catalyse economic growth and diversification in our cities and regions. &nbsp

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

Redesign and commissioning of sexual health services in England – a qualitative study

Objectives Responsibility for the commissioning of sexual and reproductive health (SRH) services transferred from the National Health Service to local authorities in England in 2013. This transfer prompted many local authorities to undertake new procurements of these SRH services. This study was undertaken to capture some of the lessons learnt in order to inform future commissioning and system redesign. Study design A qualitative study was carried out involving semi-structured interviews. Methods Interviews were conducted with 13 local authority sexual health commissioners in Yorkshire and the Humber from 11 interviews. Thematic analysis was used to identify themes from transcripts of the interviews with the 13 participants. Results Key themes identified were as follows: the challenge and complexity to those new to clinical commissioning; the prerequisites of robust infrastructural inputs to undertake the process, including technical expertise, a dependable project team, with clarity over the timescales and the budget; the requirement for good governance, stakeholder engagement and successful management of relationships with the latter; and the need to focus on the outcomes, aiming for value for money and improved system performance. Conclusions Several key issues emerged from our study that significantly influenced the outcome of the redesign and commissioning process for sexual health services. An adapted model of the Donabedian evaluation framework was developed to provide a tool to inform future system redesign. Our model helps identify the key determinants for successful redesign in this context which is essential to both mitigate potential risks and maximize the likelihood of successful outcomes. Our model may have wider applications

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

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

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