Whither Capitalism? Financial externalities and crisis

As with global warming, so with financial crises – externalities have a lot to answer for. We look at three of them. First the financial accelerator due to ‘fire sales’ of collateral assets -- a form of pecuniary externality that leads to liquidity being undervalued. Second the ‘risk- shifting’ behaviour of highly-levered financial institutions who keep the upside of risky investment while passing the downside to others thanks to limited liability. Finally, the network externality where the structure of the financial industry helps propagate shocks around the system unless this is checked by some form of circuit breaker, or ‘ring-fence’. The contrast between crisis-induced Great Recession and its aftermath of slow growth in the West and the rapid - and (so far) sustained - growth in the East suggests that successful economic progress may depend on how well these externalities are managed

"Bridging the Gap”: Assessing the Efficacy of Co-Locating a Physical Health Clinic in a Community Mental Health Setting

Background: This rapid evaluation study aimed to assess the efficacy of a physical health clinic (PHC) within Laurel House and Kings Road Practice, a community-based mental health service for adults with moderate to severe mental health needs in Kent and Medway, UK. The clinic, led by Dr Will Davis, provides support and treatment for adults aged 18-65 with moderate to severe mental health needs. The study used a mixed-methods approach, combining audit data and qualitative semi-structured interviews with seven health practitioners involved in the PHC between January and March 2023. This methodological choice was aimed at gaining a comprehensive and holistic understanding of the PHC practice. Quantitative Data Results: The quantitative data shows that the PHC had 170 referrals since its inception and provides high value to the community Mental Health Team. Of the group reviewed (n=87) 37% Did Not Attend (DNA), although this is not uncommon in the mental health sector, it highlights the need for strategies to improve patient attendance and reduce the associated impact on healthcare resources. The core physical health needs discussed in appointments were related to weight management, highlighting a specific demand in this area for service users. The clinic is focused on providing a service user-centered approach, with the main value being on general reviews of the service user's health and addressing any concerns they may have. In addition, it pays attention to any other concerns the service user may discuss during appointments and can help with any issues related to accessing GP services. The clinic also collects and records Core Physical Health Data during appointments. Qualitative Data Results: Qualitative analysis of the data identified three main themes: Service user Outcomes, Collaborative Working Practices, and Resource Management. The subthemes under Service user Outcomes include addressing health inequality, physical health objectives, service user-centered care, and time. The subthemes under Collaborative Working Practices include the benefits of having a GP in the mental health team, supportive staff culture, clinician skills, knowledge and understanding, risk management, training, experience, development, and support value. The subthemes under Resource Management include communication systems and administration, referral pathways and information exchange, and cost-benefit opportunities. Conclusions: Overall, the evaluation found the PHC to be effective in providing support and treatment for service users with severe mental illnesses. The clinic's service user-centered approach and collaborative working practices contributed to positive outcomes for service users, additionally there were opportunities identified that have cost-benefit saving to primary health, particularly within the area of weight management advice, and the gathering of Physical Health Core Data. Findings also suggest that the combination of the in-house clinic together with the expertise of the PHC GP has high value from the perspective of the Community Mental Health Team. However, resource management could be improved, particularly in the areas of communication systems and referral pathways, potentially addressing the DNA rates. The report recommends that the physical health clinic continues to be offered within Laurel House, and further research is needed to assess the long-term impact on service user outcomes

Carrots and Sticks in Bank Governance: Time for a Bigger Stick?

Purpose — This paper is pre-occupied with how bank governance can be altered to reduce risk taking and engender greater financial stability. Design/methodology/approach — Its approach is to review existing bank governance arrangements, contemporary challenges, and alternative reforms. Findings — It is argued that recent reforms are incomplete. Greater countervailing incentives for bank managers and shareholders are required. This prompts an inquiry into the merits and demerits of four types of reform: changes to executive compensation arrangements; the introduction of a liability standard for directors; the removal of limited liability for bank shareholders; and a criminal offence for managers. Originality/value — Discussion illumines several problems with the current approach to bank governance and provides insights that can help direct future reform

Move your money? Sustainability Transitions in Regimes and Practices in the UK Retail Banking Sector

We present and test a new conceptual framework for understanding sustainable transitions in co-evolutionary sociotechnical systems. We apply this in the first study of sustainable transitions in UK retail banking. This system has suffered recently from banking crises, and links to environmentally-sensitive industries such as fossil fuels. Sustainability-focused values-based banks are a potential solution, but have had little impact on mainstream banking systems. We aim to understand the constraints on a potential transition and how to overcome them. Our new approach identifies the intersections between transitions in regimes (using the multi-level perspective MLP) and transitions in practices (using social practice theory SPT), two competing conceptual frameworks in the literature. We ask: what are the intersections between transitions in the banking regime and banking practices, and how may critical points of constraint be unlocked to become points of opportunity, thereby aiding a transition to more sustainable banking systems? We present new empirical findings from a mixed-method case study of the UK banking sector and two values-based banks in particular. Interventions for growing sustainable banking are identified and we demonstrate the added-value of the combined approach through indicating strategies for unlocking the transformative potential of sustainable innovations

Meta-Analysis of Genome-Wide Association Studies for Abdominal Aortic Aneurysm Identifies Four New Disease-Specific Risk Loci

Rationale: Abdominal aortic aneurysm (AAA) is a complex disease with both genetic and environmental risk factors. Together, 6 previously identified risk loci only explain a small proportion of the heritability of AAA. Objective: To identify additional AAA risk loci using data from all available genome-wide association studies (GWAS). Methods and Results: Through a meta-analysis of 6 GWAS datasets and a validation study totalling 10,204 cases and 107,766 controls we identified 4 new AAA risk loci: 1q32.3 (SMYD2), 13q12.11 (LINC00540), 20q13.12 (near PCIF1/MMP9/ZNF335), and 21q22.2 (ERG). In various database searches we observed no new associations between the lead AAA SNPs and coronary artery disease, blood pressure, lipids or diabetes. Network analyses identified ERG, IL6R and LDLR as modifiers of MMP9, with a direct interaction between ERG and MMP9. Conclusions: The 4 new risk loci for AAA appear to be specific for AAA compared with other cardiovascular diseases and related traits suggesting that traditional cardiovascular risk factor management may only have limited value in preventing the progression of aneurysmal disease