Epidemics

This chapter reflects on the changing nature of humanitarian engagement with epidemics. Case studies analysing outbreaks of cholera in North Kivu, Zaire in 1994 and Haiti in 2010 as well as an outbreak of polio in the Horn of Africa in 2013 demonstrate the importance of looking behind narratives of ‘success’ and ‘failure’ to explore the challenges facing humanitarian agencies working in diverse social, political and resource-poor settings. Many of these challenges remain enduring, with the recent outbreak of Ebola in West Africa demonstrating that both the scale and nature of humanitarian assistance is currently being shaped by narratives linking health and disease with global security. It is also evident that assistance tends to be more effective in those places where humanitarian agencies co-ordinate their activities, while simultaneously adapting their work to the unique social, political and economic contexts in which epidemics occur

Doing research in care homes: the experiences of researchers and participants

The UK Prime Minister's Challenge on Dementia 2020 includes a target for more research to be conducted in care homes, yet research in care homes can be complex, as they are both homes and workplaces. We reflect on our experiences as researchers on a mixed methods study in six care homes over a year. We include the experiences of care home residents, their family and friends, and members of staff. Care home staff turnover was high, funding was constrained and priorities often differed from those of the researchers. Negotiating ongoing access and data collection was therefore challenging at times. Most residents did not mind taking part, but those who preferred not to felt able to decline. Private space was limited. Research in care homes needs to be adequately planned and resourced, including funding for staff time, if staff, residents and visitors are to participate in a meaningful way

Can general practitioner commissioning deliver equity and excellence? : Evidence from two studies of service improvement in the English NHS

Objectives: To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services. Methods: Qualitative data from two studies of service improvement in the English NHS were considered against England's plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009. Results: Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the 'pivotal role' of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system. Conclusions: This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity

Integrated policy making in England for adults with long-term neurological conditions (LTNCs): some preliminary findings from a scoping study

Introduction: Long-term neurological conditions are a major cause of disability in the UK and internationally. Their successful management, in order to enhance health and well-being, requires both sophisticated organisation across a number of health, social care and other service boundaries, and the real involvement of people with neurological conditions and members of their support networks. <br><br> Policy development: This paper reports on part of the preliminary scoping phase of a study designed to evaluate the impact of the National Service Framework for long-term neurological conditions on integrated care. It describes current policies in England and reports on discussions with a range of people involved in the planning, provision or use of services, which took place during the scoping exercise. These interviews inform how policy affecting people with long-term neurological conditions has been received and implemented so far. <br><br> Conclusion and discussion: Findings suggest that progress towards integrated service provision is patchy and slow. In the competing priorities within government policy, neurological conditions have tended to be marginalised, within healthcare policy generally and in initiatives to support people with long-term conditions in particular. The reasons for this are explored and will inform the next stages of the research

Taking Streets Seriously

In many parts of Gauteng, streets are congested with cars, trucks, minibus taxis, pedestrians, and informal traders. In other parts, streets are quiet, underutilised and frequently underserviced. The surface quality of the city-region’s streets varies widely – from the engineering marvel of the Gauteng Freeway Improvement Project to those (relatively few) remaining gravel or dirt roads. Besides these contrasts, there are many other degrees of quality by which Gauteng’s streets vary. In some parts of Gauteng, streets have become privatised or heavily securitised. The phenomenon of ‘gated’ communities either manifests as enclosed streets within private estates or as closed-off existing public-road networks in older suburban areas. Some streets are patrolled by security guards, lined with high walls and electric fences, and surveyed by CCTV cameras. In busy areas, informal traders sell their wares on the pavement or at traffic lights, adding to the congestion on narrow sidewalks. These activities are subject to varying levels of control and police harassment, where by-laws dictating the use of roads and pavements are haphazardly enforced, with trading goods or café tables randomly confiscated across the city. And, like many other features of the urban environment, the quality of Gauteng’s streets is highly uneven. This Research Report, ‘Taking Streets Seriously’, interrogates how what is considered good urban design and liveability of streets may shift in different contexts. Through a series of case studies it attempts to understand the various logics at play in Gauteng’s streets – not only the logics of their designers, builders or managers, but also of those who inhabit, use, or otherwise interact with them. The studies unearthed a complex interplay of actors on Gauteng streets, with street users, property owners and the state each operating according to their own, diverse agendas, contingent on the particular street in question. The result is streets that are chaotic, contested, and changing over time. It is fair to say that, with only a few exceptions, Gauteng’s streets were and continue to be designed with hostility or a studied disregard towards anyone not behind a steering wheel. Yet despite the dominance of cars, pedestrian activities do proliferate. While indubitably car-centric, they are nonetheless sites of diverse and vibrant 'non-motorised' life. This vibrancy is no thanks to those who constructed and now control our streets. Non-car users have only made their mark by contesting the territory of the street using a variety of tactics. With this Research Report, we hope to prompt a re-imagination of our streets, not least as streets rather than roads, but also as public spaces. Streets comprise by far the majority of public space in contemporary Gauteng, where other forms, such as plazas and parks, are woefully inadequate. Streets taken seriously – not by users, who have little choice, but by their designers, planners, and managers – have enormous potential to enable and encourage public life in Gauteng’s cities. Conversely, streets that are poorly made or neglected outright can constrain both the society and economy of a city. Ultimately, we hope to correct an official urban discourse that overlooks the many uses to which streets are and could be put. In a time of enormous excitement and corresponding investment in our cities, we would like to see some of both these factors directed towards the (re)development of our streets.AP201

How do pre-service teachers experience becoming a primary teacher of mathematics in the context of a mastery agenda?

This thesis examines the experiences of six pre-service teachers, learning to teach primary mathematics in the North East of England at a time of education reform, aimed at improving mathematics education. Frequently described as ‘the mastery agenda’, these reforms seek to change mathematics teaching practices in ways that replicate those observed in East Asian jurisdictions. The study takes a situated view of learning to teach primary mathematics. Pre-service teachers must negotiate often conflicting demands of themselves and those involved in their professional development. Add to this the complexity of implementing ‘the mastery agenda’, and the threads become further tangled. Pre-service primary teachers are compelled to navigate the world of reform that requires them to make sense of promoted values and practices whilst engaging in communities of practice within a school context, in which senior leaders and teachers have or are in the process of navigating and interpreting government-promoted values and practices. Driven by England’s performance in mathematics in international league tables, such as the Programme for International Student Assessment (PISA), government-promoted mathematics teaching practices in England, found in higher-performing jurisdictions, are now synonymous with ‘mastery’ in mathematics, although the term remains ill-defined and often misunderstood. Through an interpretivist, multiple case study methodology applied with reflexivity, the findings of this study suggest that despite the reforms, many longstanding issues in primary mathematics education, and primary mathematics teacher education remain unaddressed. These include matters relating to the subject and pedagogical knowledge development of pre-service primary teachers and of their mentors, the prevalence of ability-thinking that hinders pupil progression, and a disjuncture between Initial Teacher Training, practice in schools and government accountability systems. It also suggests a need for a cultural shift in attitudes towards mathematics education through sustained investment if the mastery in mathematics initiative is to succeed in its goals

The effectiveness of personal budgets for people with mental health problems : a systematic review

BACKGROUND: Personal budgets are a key policy priority in adult social care in England and are expected to become increasingly important in the care of adults with mental health problems. AIMS: This article systematically reviews evidence for the effectiveness of personal budgets for people with mental health problems across diverse outcomes. METHODS: The review, conducted in 2013, used the EPPI-Centre methodology for conducting a systematic review informed by Social Care Institute for Excellence guidelines. Data were extracted from studies and combined using meta-synthesis. RESULTS: Fifteen studies were included in the review which found mostly positive outcomes in terms of choice and control, quality of life, service use and cost-effectiveness. However, methodological limitations make these findings rather unreliable and insufficient to inform personal budgets policy and practice for mental health service users. CONCLUSIONS: Further high quality studies are required to inform policy and practice for mental health service users, which lags behind other adult social care groups in the use of personal budgets

Vision rehabilitation services : what is the evidence? Final report.

Sight loss affects all aspects of well-being including daily functioning and mental health. Demographic trends suggest that the number of people with visual impairment is set to rise significantly, with many people experiencing an additional disability or health problems. By 2050, the number of blind and partially sighted people in the UK is estimated to increase by around 122 per cent, to approximately four million. Promoting preventive and rehabilitation interventions is recognised as a high priority for all care settings as a way of reducing demands on health and social care services. This research, funded by the Thomas Pocklington Trust, aimed to provide an overview of the evidence base for community-based vision rehabilitation services for people over the age of 18 with visual impairment. The study focused on rehabilitation services funded by local authorities to find out how these services are currently supporting people with visual impairment, what possible outcomes they might achieve and to identify gaps in the evidence base about current service arrangements. The study was carried out in England. Findings were intended to inform a future full scale evaluation as well as inform services