Public sector restructuring and regional development: the impact of compulsory competitive tendering in the UK

This paper contributes to the analysis of contemporary public sector restructuring in the UK through an evaluation of the impact of the introduction of compulsory competitive tendering (CCT) for the provision of local public services. Public services play an important stabilizing role in regional economic development but the introduction of CCT has undermined that role. Public service workers have suVered deteriorating levels of pay and conditions of service, and the capacity of local authorities to act to support local economic development has been reduced. Thus the introduction of CCT has undermined the contribution of local public services to the maintenance of interregional economic stability and to regional development

Does Choose & Book fail to deliver the expected choice to patients? A survey of patients' experience of outpatient appointment booking

Provisional abstract: Background: Choose and Book is a central part of the UK Government patient choice agenda that seeks to provide patients with a choice over the time, date and place of their first outpatient appointment. This is done through the use of a computerised booking system. After a 2004 pilot study, Choose and Book was formally launched in January 2006. This is the first study of patient experience of Choose and Book since then. Methods: A questionnaire survey of reported experience of choice over the time, data and place of appointment, carried out in a National Health Service hospital in London. 104 patients at their first outpatient appointment completed the questionnaire, consisting of a consecutive series of patients referred through Choose and Book and a sample referred through the conventional booking system. Results: Among the Choose and Book patients, 66% (31/47; 95% CI 52 to 78%) reported not being given a choice of appointment date, 66% (31/47; 95% CI 52 to 78%) reported not being given a choice of appointment time, 86% (37/43; 95% CI 74 to 94%) reported being given a choice of fewer than four hospitals in total and 32% (15/47; 95% CI 20 to 46%) reported not being given any choice of hospital. Conclusions: In this study, patients did not experience the degree of choice that Choose and Book was designed to deliver

Devolving the heartland: making up a new social policy for the 'South East'

Devolution appears to challenge the traditional regional and national hierarchies of the UK, but in practice the dominance of the South East of England has been maintained through active state intervention. As social welfare has increasingly been redefined through economic success and access to the labour market, the focus of social policy has shifted accordingly. In this context the South East has been re-imagined not as a symbol of inequality and a potential source of redistribution, but rather as driver of economic prosperity and 'national' (UK) well-being

Displaced and vulnerable: A case study of ‘out of area’ housing

This is an accepted manuscript of an article published by Emerald in Housing, Care and Support on 18/09/2020. The published version can be accessed here: https://doi.org/10.1108/HCS-05-2020-0005 The accepted version of the publication may differ from the final published version

The fields of HIV and disability: past, present and future

This article provides an historic overview of the fields of disability and HIV. We describe this area of concern in terms of "fields" versus "a single field" because of the two related but distinct trends that have evolved over time. The first field involves people living with HIV and their experiences of disability, disablement and rehabilitation brought on by the disease and its treatments. The second involves people with disabilities and their experiences of vulnerability to and life with HIV. These two fields have evolved relatively independently over time. However, in the final section of this article, we argue that the divide between these fields is collapsing, and that this collapse is beginning to produce a new understanding about shared concerns, cross-field learning and the mutual benefits that might be realized from integrating policy and programmatic responses. We close by identifying directions that we expect these merging fields to take in the coming years

The health needs and healthcare experiences of young people trafficked into the UK

Young people who have been trafficked may have experienced significant trauma and violence but little is known about their health and healthcare needs. This UK study aimed to address that gap. It included a health survey and qualitative interviews with 29 young people aged 16–21 trafficked into the UK from other countries who were recruited through voluntary organisations and children’s social services. These data were supplemented by interviews with relevant professionals. Over half the young people had been trafficked for sex work but sexual violence had also been experienced by those trafficked for domestic servitude and labour exploitation. Physical violence, threats, restrictions of liberty and deprivation were also widespread, as were experiences of physical and sexual violence prior to being trafficked. Five young women had become pregnant whilst trafficked; three were parents when interviewed. Two-thirds screened positive for high levels of psychological distress, including PTSD. Twelve reported suicidal thinking. Whilst some were keen for opportunities to talk to health professionals confidentially and wanted practitioners to treat their accounts as credible, others wanted to forget abusive experiences. Complex gatekeeping systems, language barriers and practitioners who failed to take them seriously limited access to healthcare. Support and advocacy were helpful in assisting these young people to navigate healthcare systems. Health professionals need to recognise and respond appropriately to trafficked young people’s often complex mental health needs and refer them to relevant services, as well as facilitating care at later times when they might need support or be more ready to receive help

Recommended level of physical activity and health-related quality of life among Japanese adults

<p>Abstract</p> <p>Background</p> <p>The benefits of a recommended level of physical activity on physiological health indicators such as morbidity and mortality are well-accepted, but less research has addressed whether or not the association between the recommended level of physical activity and a health-related quality of life (HRQOL) exists in the Japanese population. Thus, the present study examined whether the recommended physical activity would be associated with HRQOL in the general Japanese middle-aged population.</p> <p>Methods</p> <p>Data were obtained from 1211 male and female respondents (39.4 ± 10.9 year, mean ± SD) from an Internet-based survey of registrants of an Internet research service. Physical activity level was estimated from the short form of the International Physical Activity Questionnaire. HRQOL was assessed with the Medical Outcomes Survey Short Form-8 questionnaire (SF-8). Based on the current national guidelines for exercise in Japan, respondents were divided into a recommended group, an insufficient group, and an inactive group according to their estimated weekly physical activity level. Multivariate analyses of covariance were utilized.</p> <p>Results</p> <p>Across both genders, the recommended group had significantly higher physical functioning (PF) scores than the inactive group (p < .05). Additionally, across both genders, the recommended group had significantly higher general health perception scores than the insufficient and inactive groups (p < .05). The recommended group had significantly higher vitality scores than the insufficient and inactive groups in males, and higher than only the inactive group in females (p < .05). The insufficient group had significantly higher PF scores than the inactive group across both genders (p < .05). The recommended group had significantly higher physical component scores than the inactive group (p = .001).</p> <p>Conclusion</p> <p>Individuals who attained the recommended level of physical activity had better scores on some dimensions of HRQOL than those who did not, suggesting that the recommended level of physical activity may be applicable not only to the physiological objective outcomes but also to some dimensions in both the physical and mental aspects of HRQOL.</p

Delivering NEET policy packages? A decade of NEET policy in England

This article explores the way in which government policy shapes the lives of young people who are not in education, employment or training (NEET). In particular it examines how the concept of NEETs is set within a specific infrastructure and discourse for managing and supporting young people. The article provides a brief history of the NEET concept and NEET initiatives, before moving on to scrutinise the policies of the Coalition Government. A key distinction is made between those policies and practices that seek to prevent young people becoming NEET from those that seek to re-engage those who are NEET. It is argued that the Coalition has drawn on a similar active labour market toolkit to the previous Labour administration, but that this has been implemented with fewer resources and less co-ordination. It concludes that there is little reason to believe that Coalition policy will be any more successful than that of the previous government, and some reason to be concerned that it will lead to young people becoming more entrenched within NEET

Breastfeeding and weaning practices among Hong Kong mothers: a prospective study

<p>Abstract</p> <p>Background</p> <p>Breastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infant's first year of life to determine the factors associated with early cessation.</p> <p>Methods</p> <p>A cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation.</p> <p>Results</p> <p>At 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months.</p> <p>Conclusions</p> <p>Breastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer.</p

Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia

<p>Abstract</p> <p>Background</p> <p>Antenatal, delivery and postnatal care services are amongst the recommended interventions aimed at preventing maternal and newborn deaths worldwide. West Java is one of the provinces of Java Island in Indonesia with a high proportion of home deliveries, a low attendance of four antenatal services and a low postnatal care uptake. This paper aims to explore community members' perspectives on antenatal and postnatal care services, including reasons for using or not using these services, the services received during antenatal and postnatal care, and cultural practices during antenatal and postnatal periods in Garut, Sukabumi and Ciamis districts of West Java province.</p> <p>Methods</p> <p>A qualitative study was conducted from March to July 2009 in six villages in three districts of West Java province. Twenty focus group discussions (FGDs) and 165 in-depth interviews were carried out involving a total of 295 respondents. The guidelines for FGDs and in-depth interviews included the topics of community experiences with antenatal and postnatal care services, reasons for not attending the services, and cultural practices during antenatal and postnatal periods.</p> <p>Results</p> <p>Our study found that the main reason women attended antenatal and postnatal care services was to ensure the safe health of both mother and infant. Financial difficulty emerged as the major issue among women who did not fulfil the minimum requirements of four antenatal care services or two postnatal care services within the first month after delivery. This was related to the cost of health services, transportation costs, or both. In remote areas, the limited availability of health services was also a problem, especially if the village midwife frequently travelled out of the village. The distances from health facilities, in addition to poor road conditions were major concerns, particularly for those living in remote areas. Lack of community awareness about the importance of these services was also found, as some community members perceived health services to be necessary only if obstetric complications occurred. The services of traditional birth attendants for antenatal, delivery, and postnatal care were widely used, and their roles in maternal and child care were considered vital by some community members.</p> <p>Conclusions</p> <p>It is important that public health strategies take into account the availability, affordability and accessibility of health services. Poverty alleviation strategies will help financially deprived communities to use antenatal and postnatal health services. This study also demonstrated the importance of health promotion programs for increasing community awareness about the necessity of antenatal and postnatal services.</p