Managing a sustainable, low carbon supply chain in the English National Health Service: The views of senior managers.

Objectives:In an effort to reduce costs and respond to climate change, health care providers (Trusts) in England have started to change how they purchase goods and services. Many factors, both internal and external, affect the supply chain. Our aim was to identify those factors, so as to maintain future supply and business continuity in health and social care.Methods:Qualitative interviews with 20 senior managers from private and public sector health service providers and social care providers in south west England. Interviews were recorded, transcribed and thematically analysed.Results:There were four areas of concern: contradictions with government legislation which caused confusion about how best to deliver sustainable solutions; procurement was unclear and created multiple approaches to purchasing bulk items at low cost; internal organizational systems needed to be reconsidered to embed sustainability; and embedding sustainability requires a review of organizational systems. There are examples of sustainability solutions throughout the National Health Service (NHS) but the response continues to be patchy. More research is needed into why some Trusts and some staff do not recognize the benefits of a core approach or find the systems unable to respond.Conclusions:The NHS is one of the major purchasers of goods and services in England and is therefore in an excellent position to encourage sustainable resource management, manufacturing, use and disposal

The challenge and impact of engaging hard-to-reach populations in regular physical activity and health behaviours: an examination of an English Premier League ‘Football in the Community’ men's health programme

OBJECTIVES: To investigate the challenges that men from hard-to-reach (HTR) populations encounter when attempting to commit to regular participation in physical activity and health behaviours, and to explore the psychological and social effects of participation in a twelve week football-led health improvement intervention. STUDY DESIGN: A twelve week football specific physical activity intervention targeting men from HTR populations was delivered by Everton Football Clubs' Football in the Community (FitC) scheme as part of a national programme of men's health delivered in/by English Premier League (EPL) football clubs. Men living in homeless shelters and/or recovering from substance misuse were recruited over a period of three months. The programme consisted of a two hour football session, twice weekly, alongside the dissemination of healthy living messages. Football sessions were conducted by a qualified FitC coach. METHODS: This research was conducted during a twelve week period of immersed practitioner-research. Ethnographic and observational methodologies were adopted. Psychosocial issues were discussed with participants through informal client-researcher interactions and data were logged via field notes. Records of attendance were logged. Participants who failed to attend a session were contacted and their reason(s) for non-attendance were recorded. Data were analysed using deductive and inductive reasoning. RESULTS: Despite the apparent ambition of the participants to regularly participate in the FitC programme, adherence to the programme was poor. Economic, environmental and social barriers to engagement in the programme were apparent. Engagement in the programme resulted in positive psychosocial developments; the development of structure, social interaction and social capital. CONCLUSION: Community based football-led health improvement programmes endorsed by professional football clubs appear well positioned to connect with, and attract, men from HTR populations. The evidence suggests that such programmes can improve psychosocial health amongst these populations. However, a bottom-up programme design and management strategy is required in order to reduce the challenges facing HTR participants when attempting to regularly engage in physical activity and health behaviours

Making Well-being an Experiential Possibility: The Role of Sport

Whilst the relationship between active participation in sport and well-being has been widely acknowledged, less attention has been paid to actually understand this relationship from the perspective of the individual. Our paper draws upon phenomenological philosophy and the existential life-world view of well-being, in order to explore how the experience of sport can help facilitate possibilities for multiple kinds and levels of well-being. In doing so, our paper highlights the multiplicity of the dimensions of well-being, and offers examples of the different paths to well-being provided by sport, thus providing ways of describing well-being experiences within a sports context that are more complex than those offered by more traditional approaches to study in this area. Within this conceptual analysis we adopt a humanistic approach that considers the multiple ways well-being can be experienced through sport as a sense of dwelling, mobility or dwelling-mobility within the life-world dimensions of temporarily, spatiality, mood, embodiment, inter-subjectivity and identity

Non-clinical community interventions: a systematised review of social prescribing schemes

Abstract Background: This review focused on evaluation of United Kingdom social prescribing schemes published in peer-reviewed journals and reports. Schemes, including arts, books, education, and exercise ‘on prescription’ refer patients to community sources of non-clinical intervention. Method: A systematised review protocol appraised primary research material evaluating social prescribing schemes published 2000-15. Searches were performed in electronic databases using keywords, and articles were screened for evaluation of patient data, referral process, assessment method and outcomes; non-evaluated articles were excluded. Results: Of 86 schemes located including pilots, 40 evaluated primary research material: 17 used quantitative methods including six randomised controlled trials; 16 qualitative methods, and seven mixed methods; 9 exclusively involved arts on prescription. Conclusions: Outcomes included increase in self-esteem and confidence; improvement in mental wellbeing and positive mood; and reduction in anxiety, depression and negative mood. Despite positive findings, the review identifies a number of gaps in the evidence base and makes recommendations for future evaluation and implementation of referral pathways

Practical compassions: repertoires of practice and compassion talk in acute mental healthcare

This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record-keeping and internal processes of quality control were seen as time-greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau-Ponty's phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power

Global trends in milk quality: implications for the Irish dairy industry

The quality of Irish agricultural product will become increasingly important with the ongoing liberalisation of international trade. This paper presents a review of the global and Irish dairy industries; considers the impact of milk quality on farm profitability, food processing and human health, examines global trends in quality; and explores several models that are successfully being used to tackle milk quality concerns. There is a growing global demand for dairy products, fuelled in part by growing consumer wealth in developing countries. Global dairy trade represents only 6.2% of global production and demand currently outstrips supply. Although the Irish dairy industry is small by global standards, approximately 85% of annual production is exported annually. It is also the world's largest producer of powdered infant formula. Milk quality has an impact on human health, milk processing and on-farm profitability. Somatic cell count (SCC) is a key measure of milk quality, with a SCC not exceeding 400,000 cells/ml (the EU milk quality standard) generally accepted as the international export standard. There have been ongoing improvements in milk quality among both established and emerging international suppliers. A number of countries have developed successful industry-led models to tackle milk quality concerns. Based on international experiences, it is likely that problems with effective translation of knowledge to practice, rather than incomplete knowledge per se, are the more important constraints to national progress towards improved milk quality

Building resilience to overheating into 1960's UK hospital buildings within the constraint of the national carbon reduction target: Adaptive strategies

The National Health Service (NHS) Estate in England includes 18.83 Mm2 of acute hospital accommodation, distributed across 330 sites. Vulnerability to overheating is clear with 15,000 excess deaths occurring nationally during the July 2003 heatwave. The installation of mechanical cooling in existing hospitals appears to be the inevitable recommendation from NHS patient safety risk assessments but the carbon implications would undermine the NHS Carbon Reduction Strategy. NHS CO2 emissions constitute 25% of all public sector emissions, equivalent to 3% of the UK total. In the post-2008 economic climate, the likelihood of wholesale replacement of the NHS Estate is significantly diminished; refurbishment is now of increasing interest to the Trusts that together make up the NHS. The research project ‘Design and Delivery of Robust Hospital Environments in a Changing Climate’ seeks to understand the environmental performance of the current NHS Estate and, from this, to establish its resilience. To this end, hospital buildings operated by four NHS Trusts are being monitored and simulated using dynamic thermal models calibrated against measured data. Adaptive refurbishment options are proposed and their relative performance predicted against the existing internal conditions, energy demands and CO2 emissions. This paper presents findings relating to one representative type building, a medium-rise ward block dating from the late 1960s. It shows that this particular type may have more resilience in the current climate than might have been expected, that it will remain resilient into the 2030s, and that relatively non-invasive measures would extend and increase its resilience whilst saving energ