Health and social care delivery research最新文献

{"title":"Family Group Conferences as an alternative to Initial Child Protection Conferences for families on the Child Protection pathway: Synopsis.","authors":"Lorna Stabler, Katrina Wyatt, Jo Day, Iain Lang, David Wilkins, Donald Forrester, Bekkah Bernheim, Alankrita Singh, Sarah O'Rourke, Jennie Hayes, Helene Prestat","doi":"10.3310/PLQS7147","DOIUrl":"https://doi.org/10.3310/PLQS7147","url":null,"abstract":"<p><strong>Background: </strong>When children are at risk of significant harm due to abuse or neglect, local authority children's services in the United Kingdom intervene to protect them and support families. This usually involves an initial child protection conference, a multiagency meeting that includes parents but rarely children or extended family. Families often experience initial child protection conferences as shaming and exclusionary, with limited focus on building sustainable plans. Family Group Conferences are a strengths-based, family-led forum used widely in children's social care. Safeguarding Family Group Conferences are an adaptation developed in some English authorities to replace initial child protection conferences, giving parents, carers, children and wider family networks a stronger voice in decision-making.</p><p><strong>Research questions and objectives: </strong>This study summarises findings from three linked peer-reviewed publications. It explored: How Safeguarding Family Group Conferences can be adopted and embedded (research question 1); What outcomes matter to families, children and practitioners (research question 2); Which families, under which circumstances, might benefit (research question 3).</p><p><strong>Design: </strong>A realist evaluation was carried out in three parts. First, an implementation strand, in which eight local authorities considered the feasibility of introducing Safeguarding Family Group Conferences, supported by workshops, peer reflection and expert input. Second, a theory development strand, shaped through consultations with practitioners, parents and care-experienced young people, identified meaningful outcomes and mechanisms. Third, in three pilot sites, researchers observed practice, interviewed families and practitioners, and collected data to test how the model worked in real-world contexts.</p><p><strong>Results: </strong>On implementation (research question 1), findings showed that successful uptake depended on leadership, strong engagement with partner agencies, resourcing, timing and having a dedicated lead. Implementation in child protection requires systemic, multilevel approaches with collaboration across agencies. On outcomes (research question 2), stakeholders identified key benefits, including greater family and child participation in planning, reduced negative experiences, improved safety through more tailored plans and better family relationships. Longer-term hopes included fewer children entering care, and more being placed with kinship carers if they did. Experiences of families and practitioners (research question 3) emphasised the value of involving wider family networks. This supported families to create more robust safety plans and gave professionals a clearer picture of children's lives. However, challenges included practitioner confidence in making referrals, and the need for clear oversight to ensure ongoing support after the conference. Limitations in the sample size","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 22","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rapid evaluation of the implementation of Digital Social Care Records in England.","authors":"Juliette Malley, Joanne Westwood, Martha Snow, Nicola Farrelly, Nicole Steils, Catherine Henderson, Cath Larkins","doi":"10.3310/GJJW2821","DOIUrl":"10.3310/GJJW2821","url":null,"abstract":"<p><strong>Background: </strong>The English Government introduced a target for 80% of Care Quality Commission registered adult social care providers to be using electronic care planning solutions by March 2024 (extended to March 2025) and made available funding to support the transition from paper to digital social care records.</p><p><strong>Objective: </strong>The study aimed to generate timely evidence to support care providers to implement digital social care records and maximise the benefit from their introduction.</p><p><strong>Design and methods: </strong>A co-created rapid evaluation, involving two data collection phases and feedback to study sites. We interviewed 30 senior leaders, 30 care staff, and 23 people who draw on care services and their relatives from 30 care providers (19 care homes, 11 home care agencies) in 4 sites across England and senior leaders of 3 digital social care record suppliers to understand experiences of adoption and implementation, and financial and economic implications.</p><p><strong>Results: </strong>Policy attention and availability of funding have driven adoption of digital social care records, saving time and delivering other benefits, although experiences varied and there was evidence of suboptimal choice of digital social care record system, alongside buyer regret and abandonment. Providers were concerned about ongoing affordability in the context of continued austerity. Implementation is time- and resource-intensive with providers experiencing similar and predictable challenges. Planning, leading, managing and resourcing implementation, including investing in training and involving all users or people affected by digital social care records, were important for mitigating and overcoming challenges. A responsive supplier able to resolve technical problems and reasonable requests for flexibility was also important. Care providers in a franchise or group were at an advantage as they could draw on additional support and the experiences of others. While some features were not used or a matter of preference, a reliable offline working feature was critical for functionality due to patchy internet access. The ability to easily upload images and conduct simple analysis improved functionality; as did the client/relative portal, although this was rarely used and clients/relatives had limited knowledge of digital social care records and their rights. Systems with greater interoperability maximised the benefit from digital social care records. Unfamiliarity with technology was a barrier to using digital social care records, but training and gradual implementation allowed time for adaptation and increased acceptance. People with poor eyesight, dexterity or English had difficulty using digital social care records. We did not find evidence of providers capturing data to assess return on investment from digital social care record introduction.</p><p><strong>Limitations: </strong>Assessing care providers' capacity to est","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 16","pages":"1-82"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accounting for unmet need in equitable healthcare resource allocation: Synopsis.","authors":"Ben Barr, Laura Anselmi, Sean Urwin, Emmanouil Mentzakis, Matthew Sutton, Shaolin Wang, Michael Anderson, Martin O'Flaherty, Christodoulos Kypridemos, Chris Bentley, Alexandrous Alexiou, Tarryn Lake, Misael Anaya-Montes, James Lomas, Miqdad Asaria, Anna Head, Brendan Collins, Richard Cookson","doi":"10.3310/GJBB1722","DOIUrl":"10.3310/GJBB1722","url":null,"abstract":"<p><strong>Background: </strong> The National Health Service uses formulae based on historic patterns of service use to distribute funding locally. These formulae are adjusted using avoidable mortality rates, to account for unmet needs and address health inequalities. We do not know whether this approach accurately reflects variation in unmet need between areas.</p><p><strong>Methods: </strong> We define need for National Health Service resources as the expected expenditure required to provide all standard National Health Services from which a population can benefit. We clarify the two components required to measure need: the relevant characteristics of the population living in each area and the cost weights indicating the expected needed expenditure associated with each of these characteristics. Four public advisor workshops were conducted to support the plain English description of the aims and methods used in the National Health Service resource allocation process. These led to the production of an animation to support public understanding of National Health Service resource allocation procedures. We developed four adjustments to the current National Health Service allocation formulae to better account for unmet need using electronic health records for England from 2010 and 2018 and linked primary care, hospital and mortality data from 2008 to 2020 from the Clinical Practice Research Datalink.</p><p><strong>Findings: </strong> Our responsiveness adjustment provides a method for more accurately estimating cost weights from regression models by only using data from those geographical areas that are better at aligning resources with patient need. Our longitudinal adjustment provides a new method for improving the way the utilisation formula accounts for supply-induced variation in utilisation, by using longitudinal data on people as they move between geographical areas. The primary care diagnosis adjustment shows how using linked data on primary care diagnosis improves the prediction of secondary care utilisation. Using data on people who have died from conditions, but who were not previously diagnosed, we estimate the proportion of people with 11 chronic diseases who were undiagnosed in each geographical area in England, providing an approach for adjusting National Health Service resource allocation formulae for unmet need due to underdiagnosis. Finally using instrumental variable methods we show that healthcare expenditure has larger effects on mortality in the middle deprivation groups, and smaller impacts in the top and bottom deprivation groups. These estimates indicate that some of our adjustments for unmet need may increase health inequalities. This highlights the need to maintain a 'health inequalities adjustment' that allocates more resources to socioeconomic groups with poor health outcomes to ensure that the National Health Service continues to help reduce health inequalities.</p><p><strong>Limitations: </strong>Limitations in the data","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 17","pages":"1-38"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the national rollout of the NHS App in England using qualitative and quantitative methods.","authors":"Felix Greaves, Chrysanthi Papoutsi, Sukriti Kc, Salina Tewolde, Claire Reidy, Bernard Gudgin, Anthony A Laverty, Azeem Majeed, Ceire Costelloe, John Powell","doi":"10.3310/XYRV6485","DOIUrl":"10.3310/XYRV6485","url":null,"abstract":"<p><strong>Background: </strong>In 2019, the NHS App was launched as a 'digital front door' to England's National Health Service, aiming to improve access to primary care, enhance patient experience, save time in general practitioner practices and promote self-care.</p><p><strong>Aims and objectives: </strong>This project aimed to identify and understand the use and acceptability of the NHS App, to measure the extent to which it improved patient experience and influences health service access, and to understand patterns of early take-up and participation.</p><p><strong>Methods: </strong>Qualitative work explored experiences and views on the acceptability of the app through 60 hours of observation in general practices, document analysis (approximately 100 documents), and 62 interviews and four focus groups with patients, carers, members of the public and staff across five general practices, as well as commissioners and policy-makers. Our theoretical approach used the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework. Quantitative work examined the impact of the NHS App on the usage of primary and secondary care, using routinely collected data. Firstly, using monthly NHS App user data at general practice level in England, descriptive statistics and time series analysis explored monthly NHS App use from January 2019 to May 2021. Secondly, data on the sociodemographic characteristics of the general practitioner-registered population and their healthcare needs at the general practitioner level were used as covariates to explore inequalities in app usage. Finally, NHS App usage data were also compared with measures of patient experience of care and care access extracted from the General Practitioner Patient Survey database.</p><p><strong>Results: </strong>The qualitative analysis guided by the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework illustrated the multiple layers of complexity when introducing a constantly shifting technology into a challenging environment such as English general practice, during and after a period of considerable societal turbulence caused by the COVID-19 pandemic. Quantitative work showed there was strong adoption of the NHS App even before the onset of the pandemic, although the introduction of the COVID-19 Pass feature was linked to a fourfold increase in downloads. Analyses by sociodemographic data found higher usage in less-deprived and less ethnically diverse practices, with a generally younger population. There were 25% lower registrations in the most deprived practices (<i>p</i> < 0.001), and 44% more registrations in the largest-sized practices (<i>p</i> < 0.001). Registration rates were 36% higher in practices, with the highest proportion of registered White patients (<i>p</i> < 0.001), 23% higher in practices with the largest proportion of 15- to 34-year-olds (<i>p</i> < 0.001) and 2% lower in practices with highest proportion of people with long-term care needs (<i>p","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 15","pages":"1-91"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing the evidence and associated service models to improve pain management in older people living with frailty: a synopsis of the POPPY mixed method, co-design study.","authors":"Lesley Brown, Deborah Antcliff, Andrew Clegg, Anne Grice, Pat Schofield, Asim Suleman, Amanda Williams, Nikki Harrison, Nicky Kime, Alan Wright, Natalie Lam, Dan Howdon, Davide Tebaldi, Rahena Mossabir, Sarah Hallas, Thomas F Crocker, Anne Forster","doi":"10.3310/GJLB4820","DOIUrl":"10.3310/GJLB4820","url":null,"abstract":"<p><strong>Background: </strong>Frailty increases vulnerability to adverse events (falls, illness) resulting in poorer health outcomes in later life. Persistent pain is common and impactful in older adults with frailty. Pain impact is potentially modifiable, and addressing it is important for supporting this population. The Pain in Older People with Frailty study aimed to generate evidence and develop service models to improve pain management for older adults with frailty and inform service provision for this underserved population.</p><p><strong>Objective(s): </strong>Phase 1: Map research evidence and synthesise findings from randomised controlled trials of multi-component pain management programmes and psychological therapies for community-dwelling older adults. Phase 2: In-depth qualitative interviews with community-dwelling older adults living with frailty and persistent pain, to explore pain experience and engagement with healthcare staff regarding pain. Phase 3: Service identification (four regions) including qualitative interviews with staff from pain service types (community, secondary care and specialist/tertiary) and generic community services to identify barriers and facilitators for older adults with pain and frailty to engage with pain management services. Phase 4: Co-design workshops with older adults, staff and commissioners to develop service guidance (supported by costing information) tailored to the needs of older adults with frailty and pain.</p><p><strong>Design and methods: </strong>Mixed-method, co-design study.</p><p><strong>Setting and participants: </strong>Phase 2: Community-dwelling adults (≥ 75 years) with frailty and persistent pain. Phase 3: Staff from pain services and community services, and service commissioners. Phase 4: Older adults, staff and third sector representatives.</p><p><strong>Data sources: </strong>Phase 1: Systematic review data; Phase 2: qualitative interview data (grounded theory); Phase 3: qualitative interview data (thematic analysis); Phase 4: workshop data.</p><p><strong>Results: </strong>Phase 1: Across 31 randomised controlled trials, intervention mechanisms included enhancing self-efficacy, promoting positive psychological strategies, refocusing attention to manage pain and engaging in physical activity to improve well-being and reduce pain impact. Most interventions showed potential benefits for older adults. Phase 2: Interviews with 26 older adults living with pain and frailty highlighted key themes: pain experience, pain acceptance, support seeking decisions and accessing support. Phase 3: Forty-two staff shared their perspectives on supporting older adults with frailty and pain. Phase 4: Findings were shared during workshops involving 47 stakeholders (older adults, general practices, staff and third sector representatives). Stakeholders proposed service recommendations. A health economist calculated per-patient cost estimates for different service models.</p><p><strong>Limitations: </st","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 18","pages":"1-42"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responding to people in danger: a community pharmacy response service for domestic abuse and suicidal ideation, a development and feasibility study.","authors":"Josie Solomon-Taylor, Rebecca Barnes, Ana Maria Barcelos, Tracey Latham-Green, Peter Knapp, Graham Law, Claire Henderson, Hayley Gorton, Mahomed Khatri, Darrin Baines, Mark Gussy","doi":"10.3310/SSWW9994","DOIUrl":"10.3310/SSWW9994","url":null,"abstract":"<p><strong>Background: </strong>Domestic abuse and suicidal ideation are highly prevalent and often co-occur. These issues are distressing and put people in danger from themselves or others. Numerous practical and psycho-social barriers inhibit help-seeking. Community pharmacies are accessible healthcare environments that deliver various public health functions. However, no studies have yet developed and tested a robust intervention for responding to domestic abuse and suicidal ideation in community pharmacy.</p><p><strong>Objectives: </strong>To co-develop a domestic abuse and suicidal ideation response service in community pharmacy; and to test whether the co-developed intervention and a future trial to evaluate it would be feasible and acceptable in community pharmacies.</p><p><strong>Design and methods: </strong>Service scope and resources were co-developed with 36 people (lay and professional) who participated in focus groups, interviews and/or workshops. A randomised feasibility trial tested the deliverability and feasibility of consenting clients and collecting study data, including data for a future economic evaluation. A nested process evaluation, comprising staff focus groups, customer interviews and a wider public survey, assessed the fidelity, acceptability and accessibility. A final feasibility workshop reviewed all feasibility objectives.</p><p><strong>Setting, participants and interventions: </strong>The service was tested for 6 months in eight intervention pharmacies in Lincolnshire. Four more pharmacies acted as controls, providing usual care. In intervention pharmacies, trained staff provided triage assessment and structured signposting to those identified at risk of domestic abuse and/or suicidal ideation.</p><p><strong>Main outcome measures: </strong>Data were collected on the number and type of relevant patient contacts from intervention and control pharmacies. Staff training was evaluated using the Continuing Professional Development-Reaction questionnaire, with before-and-after data analysed via paired <i>t</i>-tests. Feasibility objectives were assessed in a multistakeholder workshop. Qualitative process evaluation data were thematically analysed.</p><p><strong>Results: </strong>Co-development participants considered community pharmacies to be an ideal service setting. Their recommendations for safety, equity, empowerment and discretion were incorporated into service design. Following training, staff showed statistically significant improvements in their perceived ability and confidence in responding to people in need of help for suicidal ideation and/or domestic abuse. The public and pharmacy customers showed positive support and acceptability. During the intervention period, 24 patients needing support were identified in the intervention pharmacies compared to two in the control pharmacies. Stakeholder workshop findings confirmed community pharmacy as an appropriate setting for a staff-initiated intervention and the dual","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 13","pages":"1-46"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving collaborative inter-agency systems and practice in self-neglect: a realist review and interview study.","authors":"David Orr, Cindy Morrison, May Nasrawy, Saeideh Babashahi, Nicky Selwyn, Natalia Hounsome","doi":"10.3310/GJDO0815","DOIUrl":"10.3310/GJDO0815","url":null,"abstract":"<p><strong>Background and aims: </strong>Self-neglect can have serious consequences for individuals' self-care, health and well-being, and requires collaboration between many practitioners, from adult social care, health, fire and rescue, environmental protection and other organisations. Yet practice reviews highlight repeated failings in working together. This National Institute for Health and Care Research-funded study aimed to identify what problems arise in interagency and interprofessional practice with self-neglect within relevant contexts, and develop realist theory describing how they might be addressed.</p><p><strong>Methods: </strong>A realist review of 41 international research publications, 273 Safeguarding Adults Reviews (local statutory reviews of interagency safeguarding practice cases where it is felt there are 'lessons to be learnt') from England, and 85 Safeguarding Adults Board policies and procedures was undertaken to map evidence on collaborative working with self-neglect. Interviews were undertaken with 69 practitioners and managers from relevant agencies, 16 people with lived experience of self-neglect and 2 family carers about their experiences of collaborative working. A selection of 100 Safeguarding Adults Reviews featuring self-neglect was analysed as a set of case studies to estimate the use of services, and costs to agencies of support. Three focus groups were held with seven practitioners to coproduce research translation for use by services from the findings. Four workshops took place to pilot this research translation with practitioners; 73 participants responded to a post-workshop survey. Follow-up interviews with nine practitioners took place to further validate the study's conclusions.</p><p><strong>Findings: </strong>The study proposes four principal programme theories of interagency dynamics with self-neglect: policies, procedures and interfaces; mutual interagency understanding of roles and task; keeping a collective focus on the person experiencing self-neglect; and management support and monitoring. Practically oriented <i>policies and procedures</i> are needed to support a common understanding and coherent response to self-neglect among different agencies. <i>Mutual interagency understanding of roles and the self-neglect task</i> should be supported through shared spaces for consultation, better understanding of each other's legal powers, careful monitoring of mismatched expectations over referral, and expectations of interprofessional 'devil's advocacy' (presenting an opposing viewpoint, whether or not held with conviction, to ensure that all objections are considered). Where mutual understanding is lacking, communication and co-operation between services is impaired. <i>Keeping a collective focus on the person experiencing self-neglect</i> becomes harder to do when practitioners' attention is absorbed by interagency processes and barriers. Practitioner networks need to achieve a shared approach, informed","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 10","pages":"1-29"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence base to inform health service configuration for abortion provision: the SACHA (Shaping Abortion for Change) multi-component study.","authors":"Kaye Wellings, Rebecca S French, Annette Aronsson, Paula Baraitser, Sharon Cameron, Caroline Free, Louise Keogh, Maria Lewandowska, Patricia Lohr, Rebecca Meiksin, Ona McCarthy, Clare Murphy, Wendy Norman, Melissa Palmer, Jennifer Reiter, Natasha Salaria, Rachel Scott, Jill Shawe, Sally Sheldon, Geoff Wong","doi":"10.3310/ASGW2227","DOIUrl":"10.3310/ASGW2227","url":null,"abstract":"<p><strong>Background: </strong>Significant changes to the nature and context of abortion provision are taking place in the United Kingdom. Empirical evidence is needed to guide efforts to respond to these changes.</p><p><strong>Objective(s): </strong>To provide an evidence base to inform optimal configuration of health services and systems in response to current and future changes in abortion provision in the UK.</p><p><strong>Design and methods: </strong>Observational study comprising five integrated components: (1) a realist review to generate evidence to guide optimal abortion provision and a scoping review of interventions aimed at preparing non-specialist health professionals to provide abortion care and support; (2) country-based case studies identifying transferable lessons for policy and practice in the UK; (3) a Knowledge, Attitude, Behaviour and Practice survey among healthcare practitioners; (4) qualitative research with women with recent experience of abortion to explore their experiences of care and support; (5) consultations with key stakeholders on the implications for policy, practice and research of findings from the research. Data collection period April 2020-January 2023.</p><p><strong>Setting and participants: </strong>Primary setting: Britain. Data-gathering sites: Canada, Sweden, Australia. Forty-eight recent abortion patients recruited via independent providers and National Health Service hospitals in England, Wales and Scotland; 771 health professionals (doctors, nurses, midwives; pharmacists); 31 stakeholders with expertise in abortion in Canada, Sweden and Australia; 15 key stakeholders with expertise in abortion research, policy and practice in Britain.</p><p><strong>Main outcome measures: </strong>Abortion-related knowledge, attitude and practice among health professionals, including inclination to provide abortion, and competence and capacity to do so. Selected trends in abortion rates and their correlates, and the views of health professionals with expertise in abortion, in Sweden, Canada and Australia. Accounts of experience and preferences among women with recent experience of abortion.</p><p><strong>Results: </strong>Patients and health professionals were found to be broadly in favour of relaxation of current laws on abortion in Britain: specifically, to dispense with the requirement for two doctors to sign authorising an abortion; to permit healthcare professionals other than clinicians to prescribe abortion medication and perform vacuum aspiration; and to allow abortion to be provided in additional suitable resourced and equipped facilities, notably community sexual and reproductive health services. Training was considered necessary to equip health professionals for an extended role in abortion provision as were permissions to licence premises other than those currently approved. Patients' assessment of abortion services in Britain was positive. Suggestions for further improvement included increasing the timeli","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 11","pages":"1-122"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising rapid prenatal exome sequencing in the NHS genomic medicine service: the EXPRESS Synopsis.","authors":"Melissa Hill, Michelle Peter, Morgan Daniel, Hannah McInnes-Dean, Rema Ramakrishnan, Emma Smith, Holly Walton, Laura Blackburn, Jane Fisher, Naomi J Fulop, Marian Knight, Caroline Lafarge, Kerry Leeson-Beevers, Rhiannon Mellis, Stephen Morris, Michael Parker, Sophie Peet, Dagmar Tapon, Wing Han Wu, Sarah L Wynn, Lyn S Chitty","doi":"10.3310/GJLC0716","DOIUrl":"10.3310/GJLC0716","url":null,"abstract":"<p><strong>Background: </strong>Prenatal exome sequencing for the diagnosis of fetal anomalies was implemented nationally in England in October 2020 by the National Health Service Genomic Medicine Service.</p><p><strong>Objective: </strong>To evaluate the new prenatal exome sequencing service to provide evidence that will inform improvements to quality of care and equity of access for parents having prenatal tests.</p><p><strong>Design and methods: </strong>Our theoretically driven, multi-site, convergent parallel mixed-methods study design combined qualitative analyses of the service, stakeholder perspectives and ethical considerations with quantitative analyses of staff experiences, clinical outcomes and cost-effectiveness. Our final data set included interviews with parents offered prenatal exome sequencing (<i>n</i> = 48) and professionals (<i>n</i> = 63), surveys with professionals (<i>n</i> = 159) and data from prenatal exome sequencing testing referrals between October 2021 and June 2022 (413 referrals and 241 prenatal exome sequencing tests) linked to National Congenital Anomaly and Rare Disease Registration Service data and the Maternity Services Data Set. The study had oversight from a Steering Group and a Patient and Public Involvement Advisory Group. The Patient and Public Involvement Advisory Group contributed to study design, developing study materials and interpreting findings.</p><p><strong>Results: </strong>Parents and professionals welcomed the introduction of a national prenatal exome sequencing service. Parents need emotional support across the testing journey, including follow-up care. A newly developed prenatal sequencing animation increased self-reported and objective knowledge of prenatal exome sequencing. Good communication and close working between genetics, fetal medicine and laboratory teams has supported successful implementation. Challenges for service delivery included increased administrative time and gaps in genomics education, particularly for midwives and fetal medicine clinicians. Local implementation varied in leadership, staffing and approaches to multidisciplinary team working. Ethical issues centred on barriers for equity of access and the intersecting timelines of prenatal exome sequencing testing and termination of pregnancy laws. Between October 2021 and June 2022, the diagnostic yield for prenatal exome sequencing was 35% (85/241) with a median turnaround time of 15 days to the final report. For 85 women who had a diagnosis, 40% had a termination of pregnancy, 18% had a stillbirth and 42% had a live birth. For women with a no findings result, 18% had a termination of pregnancy, 5% had a stillbirth and 78% had a live birth. The median gestational age at termination was 26 weeks. Total National Health Service costs for the 413 cases in the study period, with the most common staffing model, was £962,727 (£775,454 to £1,204,027, 95% credibility interval), or £2331 per case referred and £3592 per case that p","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":"14 14","pages":"1-40"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accounting for Needs in Geographical Health Care Resource Allocation.","authors":"Ben Barr, Chris Kypridemos, Anna Head, Miqdad Asaria, Laura Anselmi, Matt Sutton, Chris Bentley, Richard Cookson","doi":"10.3310/GJBB0820","DOIUrl":"10.3310/GJBB0820","url":null,"abstract":"<p><strong>Background: </strong>Many countries use geographical funding formulae to distribute public funds for health care to local planning areas in proportion to need. In England, these aim to distribute resources in proportion to all healthcare needs regardless as to whether these are currently met or unmet. The National Health Service also has an additional objective to allocate resources to reduce health inequalities (i.e. differences in health between socioeconomic groups). Adjusting for unmet needs could help achieve this second objective, if a greater proportion of needs are unmet in disadvantaged socioeconomic groups with poorer health compared to more advantaged socioeconomic groups. Alternatively, if there are greater unmet needs for relatively expensive conditions that tend to affect older age groups (e.g. cancer), this could lead to a greater proportion of needs being unmet in more advantaged socioeconomic groups, who will tend to be older due to greater life expectancy. Adjusting for unmet needs would then lead to allocation of a greater share of resources to these more affluent populations with better health, potentially increasing health inequalities. It is, however, unclear how met and unmet healthcare needs should be measured in these formulae and how better accounting for unmet needs influences health inequalities.</p><p><strong>Aim: </strong>We outline a framework for estimating the relative need in geographical healthcare resource allocation and show how the distribution of needed resources between local health planning areas in England changes when accounting for unmet needs due to underdiagnosis for 11 long-term conditions.</p><p><strong>Design: </strong>We derive a synthetic data set for all people aged ≥ 30 years in England, in 2018, including age, sex, socioeconomic deprivation, region, local health planning area and whether people have diagnosed or undiagnosed long-term conditions. We calculated the annual primary and secondary care costs for each condition using linked electronic healthcare record data, then estimated needed expenditure for each health planning area for two scenarios: (1) when only accounting for diagnosed cases and (2) including all cases (diagnosed and undiagnosed). We examine how the distribution of need between places changes between these scenarios and the consequences of this for health inequalities.</p><p><strong>Results: </strong>Based on the estimates of underdiagnosis used, areas with the lowest overall needs tended to have a greater proportion of their needs unmet. Adjusting resource allocation by accounting for these unmet needs due to underdiagnosis would move resources from areas with the highest level of needs to areas with lower overall needs. Moving to this 'fair share distribution' would tend to benefit less deprived areas more than more deprived areas, potentially widening health inequalities.</p><p><strong>Conclusion: </strong>We show how accounting for unmet needs due to underdiag","PeriodicalId":519880,"journal":{"name":"Health and social care delivery research","volume":" ","pages":"39-54"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}