Contracting for Social Cohesion: Can Local Area Agreements Make a Difference?

Summary. Under the Labour government, Local Strategic Partnerships (LSPs) in England were responsible for the delivery of Local Area Agreements (LAAs) – agreed targets between central and local government. This paper uses statistical techniques and local authority case studies to explore the impact of LAAs on LSPs’ efforts to promote social cohesion. The results suggest that LSPs with an LAA for social cohesion experienced a better rate of improvement in community cohesiveness than those without, and that tougher targets resulted in stronger improvement. The impact of changes in LSPs approaches to promoting social cohesion appears to be responsible for this finding

Public management reforms and emerging trends and effects on social cohesion in Europe

__Abstract__ During the past thirty years or so, governments across Europe have grown ever more accustomed to developing initiatives to enhance the performance of key institutions and organizations. At the same time as being subject to the introduction of wide-ranging management reforms, many of those institutions and organizations are now increasingly charged with responding effectively to complex and intractable social problems. Amongst the so-called “wicked issues” public organizations are expected to address is the cohesiveness of the societies that they serve. In fact, European governments have implemented a swathe of initiatives designed to prompt public organizations to devote more energy to addressing the supposed centrifugal tendencies associated with globalisation and the breakdown of traditional social structures. In this context, the main objective of this report is to analyse emerging trends in social cohesion, beginning with socio-economic influences on social solidarity and social order in Europe before evaluating whether public management matters. To do so, the report draws upon primary and secondary research carried out in the COCOPS Work Packages 1-5, and blends this with analysis of Eurobarometer data and interviews with European policy-makers carried out specifically for Work Package 6. The findings of the report suggest first that social cohesion is largely determined by socio-economic disadvantage and that the economic strain associated with the financial crisis has also had a detrimental effect on the cohesiveness of European societies. At the same time, public management also matters, with some reforms and practices found to have beneficial effects for social solidarity and social order – though some others were found to have a negative effect. Since it seems that public management can make a positive difference to the cohesiveness of society, there is good reason for the countries of the EU to continue to invest in developing better policies aimed at promoting social cohesion

Setting the stage for health: Salutogenesis in midwifery professional knowledge in three European countries

There is a lack of systematic evidence concerning health orientation in maternity practice in the current climate of risk avoidance. The midwifery professional project is orientated toward the preservation of normal physiological processes during the maternity episode. This study investigates accounts of midwives who were working in health-orientated birth settings, to examine if and how they frame a health orientation in professional practice. Twenty-seven narrative interviews were conducted with midwives working in pre-, peri-, and postnatal care in different maternity care settings in Switzerland, Austria, and Germany. In-depth and comparative pattern data analyses were conducted. The distinct practice orientation of the participants was revealed in three main concepts, underpinned by a common framework mirroring the three parameters of the Sense of Coherence (comprehensibility, manageability, and meaningfulness) described in Aaron Antonovsky's salutogenic theory. The midwives’ implicit salutogenic knowledge shaped their reported actions in supporting mothers, fathers, and families to have health-promoting experiences in maternity care. These results suggest that an implicit health orientation in maternity care practice can be prefered through examination of the practice reports of midwives working in settings that have a health-promoting philosophy. Implications for midwifery practice and research are discussed. Consideration is given to the relevance of the results for debates about avoiding overtreatment and for the operationalization of salutogenic theory in health care practice

The role of healthcare professionals in encouraging parents to see and hold their stillborn baby: a meta-synthesis of qualitative studies.

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final