The end of the beginning? Taking forward local democratic renewal in the post-referendum North East.

This article draws upon the author’s commissioned research on the nature of regional governance following the 2004 Referendum in the North East on elected regional assemblies. The article aimed to both capture these views and to assess how the ‘No vote in the referendum has impacted on subsequent developments in sub-national governance. The article provides both an empirical overview of recent developments and engages with the wider conceptual debates on democratic renewal. The arguments covered in this output are aimed at both academic and practitioner audiences, and have been also disseminated at regional and national conferences

The Muslim problematic: Muslims, state schools and security

Muslims are folk-devils that mark the ubiquitous moral panic. For some, the idea of the Muslim problematic signifies a long and worrying trend of creeping ‘Islamification’ of state schools. For others, the discourse of the Muslim problematic reflects the ongoing racial patholigisation of Britain’s minoritised communities. One thing is for certain, the current debate marks a significant moment in the nature and function of the neoliberal state as it reframes race relation policy in Britain in the light of the security agenda. The Trojan Horse affair, surrounding claims of infiltration of radical Islam in state-run schools, marks a significant moment in the embedding of the security agenda in Britain’s inner city schools through the medium of the Prevent agenda. It argues that one of the best ways of understanding the security agenda is by locating it within a broader sociological and historical context of the functioning of the racial state

The impact of open data in the UK: complex, unpredictable, and political

This article examines the democratic impact of the UK coalition government's Transparency Agenda, focusing on the publication of all local government spending over £500 by councils in England. It looks at whether the new data have driven increased democratic accountability, public participation, and information transmission. The evidence suggests that the local government spending data have driven some accountability. However, rather than forging new ‘performance regimes’, creating ‘armchair auditors’, or bringing mass use and involvement, the publication creates a further element of political disruption. Assessment of the use and impact of the new spending data finds it is more complex, more unpredictable, and more political than the rhetoric around Open Data indicates. The danger is that the gap between aims and impact invites disappointment from supporters

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

Background: Bariatric surgery is known to be an effective treatment for extreme obesity but access to these procedures is currently limited. Objective: This study aimed to evaluate the costs and outcomes of increasing access to bariatric surgery for severe and morbid obesity. Design and methods: Primary care electronic health records from the UK Clinical Practice Research: Datalink were analysed for 3045 participants who received bariatric surgery and 247,537 general population controls. The cost-effectiveness of bariatric surgery was evaluated in severe and morbid obesity through a probabilistic Markov model populated with empirical data from electronic health records. Results: In participants who did not undergo bariatric surgery, the probability of participants with morbid obesity attaining normal body weight was 1 in 1290 annually for men and 1 in 677 for women. Costs of health-care utilisation increased with body mass index category but obesity-related physical and psychological comorbidities were the main drivers of health-care costs. In a cohort of 3045 adult obese patients with first bariatric surgery procedures between 2002 and 2014, bariatric surgery procedure rates were greatest among those aged 35–54 years, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. During 7 years of follow-up, the incidence of diabetes diagnosis was 28.2 [95% confidence interval (CI) 24.4 to 32.7] per 1000 person-years in controls and 5.7 (95% CI 4.2 to 7.8) per 1000 person-years in bariatric surgery patients (adjusted hazard ratio was 0.20, 95% CI 0.13 to 0.30; p<0.0001). In 826 obese participants with type 2 diabetes mellitus who received bariatric surgery, the relative rate of diabetes remission, compared with controls, was 5.97 (95% CI 4.86 to 7.33; p<0.001). There was a slight reduction in depression in the first 3 years following bariatric surgery that was not maintained. Incremental lifetime costs associated with bariatric surgery were £15,258 (95% CI £15,184 to £15,330), including costs associated with bariatric surgical procedures of £9164 per participant. Incremental quality-adjusted life-years (QALYs) were 2.142 (95% CI 2.031 to 2.256) per participant. The estimated cost per QALY gained was £7129 (95% CI £6775 to £7506). Estimates were similar across gender, age and deprivation subgroups. Limitations: Intervention effects were derived from a randomised trial with generally short follow-up and non-randomised studies of longer duration. Conclusions: Bariatric surgery is associated with increased immediate and long-term health-care costs but these are exceeded by expected health benefits to obese individuals with reduced onset of new diabetes, remission of existing diabetes and lower mortality. Diverse obese individuals have clear capacity to benefit from bariatric surgery at acceptable cost. Future work: Future research should evaluate longer-term outcomes of currently used procedures, and ways of delivering these more efficiently and safely

Is the grass always greener? Making sense of convergence and divergence in regeneration policies in England and Scotland

This paper is concerned with the trajectories of regeneration policy discourse and practice in a devolved UK context. Over recent years the asymmetrical nature of devolved governance has intensified, exemplified by a policy of political containment in Scotland and a reconfiguration of sub-national institutional architecture in England. Against a backdrop of the transfusion of Holyrood’s devolution agenda and Westminster’s localism programme, an empirical analysis of contemporary English and Scottish regeneration policy is provided. We investigate the extent to which perceived divergences in government policy resonate with those at the sharp end of regeneration practice, informed by concepts derived from the policy convergence/divergence literature. The key finding is the coexistence of ideological divergence, replete in political discourse and policy documentation, but growing convergence in actual existing practice, evidenced in the nature, extent and scale of initiatives. The enveloping fiscal context and austere politics, producing what is anticipated to be a protracted period of financial retrenchment, appears to be a defining factor in contemporary urban regeneration policy convergence

The role of law in the control of obesity in England : looking at the contribution of law to a healthy food culture

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article is available from: http://www.anzhealthpolicy.com/content/5/1/21 DOI: 10.1186/1743-8462-5-21Obesity levels in England are significantly higher than in much of the rest of Europe. This article examines aspects of the physical and cultural context of food consumption in England, and the evolution of government policy on obesity, as a background to an analysis of how law might play a role in obesity prevention. Research suggests that individual food choices are associated with cultural and socio-economic circumstances and that they can be manipulated by advertising, food packaging and presentation. This suggests that there might be ways of using law to manage the influences on food choices, and of using law in support of strategies to redirect food choices towards healthy food products. Law is a particularly useful tool in the protection of the individual against the economic power of the food industry, and there is much that law can do to change the physical, economic and social environment of food consumption.Peer reviewe