Using Geographic Information Systems to investigate variations in accessibility to ‘extended hours’ primary healthcare provision

There are ongoing policy concerns surrounding the difficulty in obtaining timely appointments to primary healthcare services and the potential impact on, for example, attendance at accident and emergency services and potential health outcomes. Using the case study of potential access to primary healthcare services in Wales, Geographic Information System (GIS)‐based tools that permit a consideration of population‐to‐provider ratios over space are used to examine variations in geographical accessibility to general practitioner (GP) surgeries offering appointment times outside of ‘core’ operating hours. Correlation analysis is used to explore the association of accessibility scores with potential demand for such services using UK Population Census data. Unlike the situation in England, there is a tendency for accessibility to those surgeries offering ‘extended’ hours of appointment times to be better for more deprived census areas in Wales. However, accessibility to surgeries offering appointments in the evening was associated with lower levels of working age population classed as ‘economically active’; that is, those who could be targeted beneficiaries of policies geared towards ‘extended’ appointment hours provision. Such models have the potential to identify spatial mismatches of different facets of primary healthcare, such as ‘extended’ hours provision available at GP surgeries, and are worthy of further investigation, especially in relation to policies targeted at particular demographic groups

Working towards co-production in rehabilitation and recovery services

PurposeThis paper outlines the work of a service provider, service user and carer group created to develop a strategy for service user and carer co-production.ApproachA reflective narrative account is given of the process through which the group formed and began to develop a working model aimed at shaping a cultural shift towards more co-produced services. The paper has been co-produced and includes the collaborative voices of service users, carers, multi-disciplinary staff, third sector representatives, managers and colleagues from associated services.FindingsThe model developed outlines 3 stages for services to work through in order to achieve meaningful and sustainable co-produced services. The importance of developing associated policies related to such areas as recruitment, payment, support and training is also outlined. Challenges to co-production are noted along with suggested approaches to overcoming these.Implications and ValueThe ethos of co-production is relatively new in the UK and so knowledge of the process and model may help guide others undertaking similar work

Exclusion from school in Scotland and across the UK:Contrasts and questions

This article draws on findings from the first cross‐national study of school exclusion in the four jurisdictions of the UK. It casts new light on the crucial aspects of children's education that lead to school exclusion. It investigates the reasons for the UK disparities, as well as the policy and practice in place. The focus of this article is on a detailed analysis of the policy context in Scotland, where official permanent exclusion reduced to an all‐time low of just five cases in 2014/15. This is much lower than in Northern Ireland and Wales and in stark contrast to England, where exclusions have increased substantially since 2012. Our analysis seeks to understand Scotland's success in reducing exclusion and offers new insight into the ways in which national policies and local factors more generally shape schools and their practices and the consequent impacts for children and young people more broadly in the UK

Implementation and the Governance Problem: A Pressure Participant Perspective

This article has two aims: to qualify the UK government's ‘problem' of governance in a comparison with Scotland and Wales, and to use implementation studies (the ancestors of the new governance literature) to explore policy developments since devolution in Britain. It presents a puzzling finding from extensive interview research: that while we may expect UK government policy to suffer a bigger ‘implementation gap' based on distinctive governance problems (such as greater service delivery fragmentation and the unintended consequences of top-down policy styles), pressure participants in Scotland and Wales are more likely to report implementation failures. Using a ‘top-down' framework, it explores three main explanations for this finding: that the size of the implementation gap in England is exaggerated by a focus on particular governance problems; that pressure participant dissatisfaction follows unrealistic expectations in the devolved territories; and that the UK government undermines devolved policy implementation, by retaining control of key policy instruments and setting the agenda on measures of implementation success

A survey of local health promotion initiatives for older people in Wales

<p>Abstract</p> <p>Background</p> <p>As the demographic profile of the UK changes, policy makers and practitioners have to respond to health challenges presented by a progressively ageing population. The health promotion plan for older people, aged over 50 years, in Wales included eight key areas: physical activity, healthy eating, home safety and warmth, emotional health, health protection, smoking, alcohol and sexual health. The aim of this study was to describe the extent, content and regional variation of existing health promotion initiatives for older people in Wales, provided by statutory, voluntary and private sector agencies.</p> <p>Method</p> <p>A questionnaire was sent to senior health promotion specialists employed in the 22 local authority areas in Wales to ascertain details of all projects promoting health and wellbeing in the eight key areas where the priority population was aged over 50, or the majority of users were older people. Additional information was sought from project leads and websites.</p> <p>Results</p> <p>Eighteen questionnaires were returned; not all were fully completed. Four areas did not return a questionnaire. Additional information was obtained from internet searches but this mainly concerned national initiatives rather than local projects. In all, 120 projects were included, 11 were throughout Wales. Best provision was for physical activity, with 3 national and 42 local initiatives, but local provision was patchy. Healthy eating, and home safety and warmth had far fewer initiatives, as did health protection, which comprised two national immunisation campaigns. Smoking and alcohol misuse were poorly provided for, and there was no provision for older people's sexual health. Evaluation arrangements were poorly described. Half of those who responded identified unmet training needs.</p> <p>Conclusion</p> <p>The reasons for patchy provision of services were not clear. Increased efforts to improve the coverage of interventions known to be effective should be made. Rigorous evaluation of projects is needed to ascertain the most effective and appropriate interventions, especially for alcohol misuse and sexual health. These conclusions are relevant to the other countries of the United Kingdom (UK), and more widely across Europe.</p

Elite City-Deals For Economic Growth? Cardiff Capital Region, Devolution and the Positioning of Civil Society Actors

The concept of localism and spatial delineation of the ‘city region’ have seen a renaissance as the de facto spatial political units of governance for economic development. One articulation of this has seen the creation of Cardiff Capital Region (CCR) to potentially enhance Wales’s poor economic performance and secure democratic forms of social cohesion. City regions have been vaunted as the ‘spatial imaginary’ for engendering economic development, but there are considerable state spatial restructuring tensions. The paper discusses these by following the development of city-regionalism in Wales and specifically the unfolding of the ‘elite-led’ CCR City-Deal

Political devolution and employment relations in Great Britain: the case of the Living Wage

This article examines the role of the devolved governments of Scotland and Wales in promoting the voluntary Living Wage. It shows that active promotion of the Living Wage standard has emerged in both countries from a broader commitment to an economic policy of ‘inclusive growth’. Employment law is not a devolved matter, and the article identifies a broad range of economic incentives and soft forms of regulation that have been used by the devolved governments to promote the Living Wage in the absence of hard power to legislate. Non‐legislative forms of state intervention are often regarded sceptically, but the article shows that the attempts of devolved governments to spread the Living Wage have been impactful, particularly in Scotland