Integrated Care : A Pill for All Ills?

There is an increasing policy emphasis on the integration of care, both within the healthcare sector and also between the health and social care sectors, with the simple aim of ensuring that individuals get the right care, in the right place, at the right time. However, implementing this simple aim is rather more complex. In this editorial, we seek to make sense of this complexity and ask: what does integrated care mean in practice? What are the mechanisms by which it is expected to achieve its aim? And what is the nature of the evidence base around the outcomes delivered

One eye or two? Determining gaze direction in the horizontal and vertical plane

Human observers are extremely accurate at determining the gaze direction of another person.The investigations reported here aimed to clarify discrepant data on whether gaze direction is easier to detect in the horizontal (Cline, 1967 American Journal of Psychology 80 41 ^ 50) or vertical plane (Anstis et al, 1969 American Journal of Psychology 82 474 ^ 489) and in monocular or binocular conditions (Symons et al, 2004 Infant Behavior and Development 21 531 ^ 536). Observers viewed photographs of a looker and it was found that vertical eye movements were easier to determine than horizontal eye movements thresholds 0.467 and 1.064 min of arc, respectively); in addition there was no difference between binocular and monocular thresholds (0.747 and 0.784 min of arc, respectively). These findings support Anstis et al's (1969) claim that vertical eye movements are easier to determine, furthermore they challenge Symons et al (2004) because presentation of both eyes is not needed to accurately determine gaze direction

Adolescents’ Mobile Phone Use While Crossing the Road

Phones and other portable technology can be a distraction for pedestrians, affecting their ability to cross a road safely. This study focused on adolescents and investigated whether using a phone distracts attention while crossing the road. A field observation outside a secondary school in the north of England was carried out over a four-week period in 2018 with permission from the school. Observations included recording what accessories the pedestrian was carrying (phone, headphones or another electronic device) and their associated action (whether they were holding the device, speaking into a phone, looking at it, holding it to their ear or interacting with it manually). We observed whether the pedestrian looked (or failed to look) left and right before crossing the road, whether they crossed when the pedestrian light was on green or red, and whether they crossed within the cross-walk. We found that 31.37% of road crossings were made by adolescents with a phone or other device. They looked left and right before crossing less frequently when they had an electronic device with them, when looking at the screen and when texting or swiping. In conclusion, the safety of adolescent pedestrians is affected by mobile phones and music players

Integrated care systems and equity:prospects and plans

Abstract Purpose – Policies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity. Design/methodology/approach – The analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities. Findings – The place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities. Originality/value – This study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to societ

Public spending must improve health, not just healthcare : A narrow focus on the NHS neglects the much wider determinants of health

Last week’s budget held few surprises for the NHS because the “star bunnies”1 had already been released from the chancellor’s hat by the prime minister, whose summer announcement included a £20.5bn (€23bn; $27bn) “70th birthday present” for the NHS.2 But, as many have noted, the extra funding committed by 2023 (3.4% a year) is relatively low compared with historical trends—average annual increases since 1948 have been around 3.7%3— and it follows a long period of very modest growth. When adjusted for need, NHS spending has risen by only 0.1% a year since 2009-10 in real terms,4 and the spending pledge is widely viewed to be only enough to get the basics back on track.5 Top line figures also ignore what is happening to different funding streams. Increases are directed at only one part of the healthcare system—NHS England—ignoring NHS infrastructure such as training, IT, and buildings, all of which are under increasing pressure, as well as spending in Wales, Scotland, and Northern Ireland. Despite the efforts of local authorities to protect social care spending, it has fallen by 1.5% a year between 2009-10 and 2016-17,4 and as the deputy chief executive of NHS Providers put it, “When social care is cut, the NHS bleeds."

O Branco estrangeiro: Contra-antropologias amazônicas do capitalismo colonial

L’anthropophagie, la déglutition de l’étranger, en tant que relation fondamentale à l’altéritéprédatrice et potentiellement affine, qui vise à se métamorphoser dans l’autre dans le but detraduire, de connaître et de prévenir, la menace que constitue le type d’humanité qu’il actualise,est le mode propre de la contre-anthropologie amazonienne, c’est-à-dire de l’anthropologie desBlancs pratiquée par les peuples de la forêt, forcés par la violence du contact colonial prolongéd’objectiver et de chercher à comprendre, pour y résister, et dans une certaine mesure latransfigurer, l’invasion de leurs mondes par l’ordre stérile du capitalisme européen. L’article sepropose d’analyser deux exemples significatifs de cette ingestion contre-anthropologique de lablanchité (whiteness) – c’est-à-dire de la réflexivité d’une humanité spéciste, sexiste etesclavagiste : le mythe de Jurupari, dans le Nord-Ouest amazonien, et le culte de Tenkowa, enGuyane française.A antropofagia, a deglutição do estrangeiro, enquanto relação fundamental com a alteridade predatora e potencialmente afim, que visa se metamorfosear no outro com o objetivo de traduzir, conhecer e prevenir a ameaça que constitui a humanidade que ele atualiza, é o modo próprio da contra-antropologia amazôniza — isto é: a antropologia dos Brancos praticada pelos povos da floresta, forçados, pela violência do contato colonial prolongado, à objetivar e tentar compreender a invasão de seus mundos pela ordem estéril do capitalismo europeu, para resistir a ela e, numa certa medida, transfigurá-la. O artigo procura analisar dois exemplossignificativos dessa ingestão contra-antropofágica da branquitude (whiteness) — isto é, da reflexividade de uma humanidade especista e escravista: o mito de Jurupari, no noroeste amazonense, e o culto de Tenkowa, na Guiana francesa

The relationship between social care resources and healthcare utilisation by older people in England : an exploratory investigation

Background Since 2010, adult social care spending has fallen significantly in real terms whilst demand has risen. Reductions in local authority (LA) budgets are expected to have had spill over effects on the demand for healthcare in the English NHS. Motivation If older people, including those with dementia, have unmet needs for social care, their use of healthcare may increase. Methods We assembled a panel dataset of 150 LAs, aggregating individual-level data where appropriate. We tested the impact of changes in LA social care resources, which was measured in two ways: expenditure and workforce. The effects on people aged 65+ were assessed on five outcomes. 1. Rates of emergency hospital admissions for falls in people with dementia aged 65 and over. 2. Rates of emergency hospital admissions for fractured neck of femur in people 65 and over. 3. Extended length of stay in people with dementia, 7 days and over 4. Extended length of stay in people with dementia, 21 days and over 5. Rates of NHS Continuing Healthcare (NHS CHC) Outcomes (utilisation) data were derived from the Hospital Episode Statistics (1, 2, 3 and 4), the Public Health Outcomes Framework (2), and publicly available datasets from NHS Digital (5). Datasets varied in the timeframes available for analysis. Planned analysis of the effects of social care cuts on delayed transfers of care in mental health trusts, and on deprivation of liberty safeguards were not undertaken because of data quality concerns. We tested the effect of two separate explanatory variables: adult social care gross current expenditure (per capita 65 and over) adjusted by area cost; and adult social care workforce staff (per capita 18 and over). Workforce measures distinguished LA and independent sector employees and included professional and non-professional staff providing direct social care. We ran negative binomial models and linear models, and controlled for a range of confounding factors, including deprivation, ethnicity, age, unpaid care, LA class and year effects. To account for potential endogeneity (‘reverse causality’), we also tested the Area Cost Adjustment (ACA) as an instrumental variable and ran dynamic panel models. Sensitivity analysis explored the effects of the additional effects of the Better Care Fund. Results The level of social care expenditure on older people was not significantly related to emergency admission rates for falls in people with dementia or for fractured neck of femur. Extended stays of 7 days or longer were significantly and positively related to the level of social care spend, but this association was no longer significant when additional spend from the Better Care Fund was taken into account. There was no significant relationship between the level of social care spend and hospital stays of 21 days or longer or between spend and uptake of NHS CHC. We also tested the effect of four social care workforce measures. LAs employing higher rates of social care staff (especially professional staff) had significantly higher levels of NHS CHC, but there was no significant relationship between LA staffing levels and the remaining four outcomes. LAs with higher levels of independent social care staffing had significantly lower rates of extended stays, but there was no association with either emergency admissions or on NHS CHC. The effect of ‘full time’ ii CHE Research Paper 174 unpaid care on outcomes was mixed, with tentative evidence of a protective effect on admissions for falls, and on extended stays of 21 days or longer. When the Area Cost Adjustment was used as an instrument in place of expenditure, results were largely consistent with the main analysis: there were negative effects on NHS CHC but no effect on any other outcome. The dynamic panel models found a positive relationship between spend and emergency admissions for falls, but the effect on other outcomes was statistically insignificant. Conclusions The study found no consistent evidence that reductions in social care budgets led to the expected rises in hospital admissions, hospital stays or uptake of NHS CHC. However, findings suggest that public sector staff providing direct social care, particularly professional staff, may be instrumental in facilitating access to NHS CHC. In addition, the study found tentative evidence that extended hospital stays are partially offset by social care provision by the independent sector and by unpaid carers providing intensive care. To test the validity and robustness of these findings, future research using linked individual-level health and social care data is needed

Key Words in the Discourse of Discrimination: A Semantic Analysis

This thesis is an inquiry into discrimination, from a semantic perspective. In the discourse of discrimination, there is a set of key words. These terms are identified as the 'processes' of discrimination, the progressive stages and manifestations of sociocultural conflict. There are several dimensions to discrimination: a 'rhetorical' dimension, consisting of the speech acts of discrimination; a 'social' dimension, including the behaviours associated with discrimination; and a 'cognitive' dimension, which includes the underlying attitudes and ideologies. This thesis presents and justifies semantic explications for a field of words pertaining to the language of abuse, hatred and the 'processes' of discrimination. The discussion is categorised into four sections, commencing with an examination of the speech act verbs: 'insult', 'abuse', 'denigrate', 'vilify' and 'offend'. Then follows an analysis of words that describe the social acts of discrimination,including 'dehumanise', 'demonise', 'marginalise', 'stigmatise' and 'discriminate'. Next is an analysis of words that describe the cognitive elements of discrimination, including 'stereotype', 'intolerance', 'prejudice', 'xenophobia', 'racism' and 'sexism'. The analysis considers aspects of semantic phenomena, including: synonymy, polysemy, metaphor and ambiguity. The final section is a treatise on overt and covert discrimination, and discusses perspectives and directions in this area of research

Local Excision Without Radiation for High-Grade Soft-Tissue Sarcoma of the Extremity and Superficial Trunk

Purpose. Limb-sparing surgery combined with radiation treatment has become the accepted treatment for patients with high-grade soft-tissue sarcoma. Adjuvant radiation was not routinely used at this institution for patients with clear margins after surgery.This retrospective review analyses the outcome of this group of patients