Joining it up? Health and Wellbeing Boards in English Local Governance: Evidence from Clinical Commissioning Groups and Shadow Health and Wellbeing Boards

Statutory responsibility for health care and social care has long been separated between National Health Service (NHS) bodies and local government authorities. Repeated policy attempts to promote service integration through collaboration between such authorities have achieved little. The latest of such policy interventions are the Health and Wellbeing Boards (HWBs) established by the 2012 Health and Social Care Act (HSCA) alongside a range of other organisational innovations, including Clinical Commissioning Groups (CCGs). These organisations await full legal and operational status but have begun to develop structures and processes. HWBs are intended to lead the integrated assessment of local needs to inform both NHS health and local authority social care commissioners. We undertook detailed qualitative case studies in eight CCGs during 2011–2012 and here report observational and interview data related to CCGs’ perspectives and observations of early HWB developments. We found that developing HWBs vary greatly in their structure and approach, but we also identified a number of significant issues that are familiar from earlier research into health and social care integration. These include heavy dependence on voluntary agreements to align the strategic plans of the many different new statutory bodies; a significant role for mundane organisational processes in determining the extent of effective co-operation; and problems arising from factors such as size and the arrangements of local boundaries.     

The association between specific competence-related abilities and competence restoration treatment

Inpatient competence restoration treatment comes with enormous costs in terms of civil liberties, but also significant financial costs to the state/institution responsible for providing the treatment. The present investigation was designed to evaluate the utility of a commonly used competence assessment instrument, the MacArthur Competence Assessment Tool – Criminal Adjudication (MacCAT-CA), in identifying individuals who may require more tailored, lengthier, and/or more intensive treatment. The sample included 93 men and women who were administered the MacCAT-CA during an inpatient hospitalization for competence restoration treatment in the United States. All of the patients were restored to competence within the study period, ranging from 3 to 32 months of inpatient hospitalization. Results suggest that performance on the MacCAT-CA was associated with hospitalization length, with total scores as the greatest predictor of response to treatment. Sensitivity and specificity estimates are discussed in terms of their utility in identifying patients most at-risk for extended hospitalization, with the authors arguing that instruments like the MacCAT-CA can be used in a practical manner of identifying patients who might require greater or more intensive treatment.     

Multidimensional Bullying Victimization Scale: Development and validation

The prevalence of bullying has increased over the past decade and is a public health concern. Existing measures of bullying lack breadth and/or psychometric support, which may inaccurately represent current rates of bullying. The purpose of this study was to develop and validate a psychometrically sound measure, the Multidimensional Bullying Victimization Scale (MBVS), to evaluate bullying in adolescents. An initial pool of items was generated and rated by 600 adolescents. Exploratory factor analyses yielded three factors—direct bulling, indirect bullying, and evaluative bullying. Confirmatory factor analyses were conducted on independent sample of 623 adolescents, supporting the original three-factor solution. Results indicate that the MBVS demonstrates good internal consistency, construct validity, and concurrent validity. The MBVS scores were significantly and positively correlated with internalizing and externalizing symptoms. The MBVS provides a reliable and valid assessment of adolescents’ experiences with bully victimization.     

Capitalizing on Criminal Accomplices: Considering the Relationship between Co-offending and Illegal Earnings

This study investigates whether co-offending offers an avenue towards criminal success. Specifically, it considers if current and prior co-offending experience is related to the probability of reporting illegal earnings as well as the amount of these earnings. Using data from the Pathways to Desistance Study, we estimated fixed-and random-effects models to test whether co-offending experience is related to self-reported illegal earnings. The models also estimated whether “historical” co-offending experience predicted current illegal earnings. Across both modeling strategies, current and historical co-offending predicted the probability of reporting non-zero illegal earnings, net of offending frequency and controls. There is minimal evidence of a relationship between co-offending experience and the amount of illegal earnings, however. These findings lead us to conclude that access to a relatively common criminal connection—the co-offender—offers tangible benefits to adolescent offenders, primarily by affecting their ability to translate criminal opportunities into monetary gain.     

Reconciling Autonomy and Beneficence in Treatment Decision-Making for Companion Animal Patients

This article explores how the concept of consent to medical treatment applies in the veterinary context, and aims to evaluate normative justifications for owner consent to treatment of animal patients. We trace the evolution of the test for valid consent in human health decision-making, against a backdrop of increased recognition of the importance of patient rights and a gradual judicial espousal of a doctrine of informed consent grounded in a particular understanding of autonomy. We argue that, notwithstanding the adoption of a similar discourse of informed consent in professional veterinary codes, notions of autonomy and informed consent are not easily transferrable to the veterinary medicine context, given inter alia the tripartite relationship between veterinary professional, owner and animal patient. We suggest that a more appropriate, albeit inexact, analogy may be drawn with paediatric practice which is premised on a similarly tripartite relationship and where decisions must be reached in the best interests of the child. However, acknowledging the legal status of animals as property and how consent to veterinary treatment is predicated on the animal owner’s willingness and ability to pay, we propose that the appropriate response is for veterinary professionals generally to accept the client’s choice, provided this is informed. Yet such client autonomy must be limited where animal welfare concerns exist, so that beneficence continues to play an important role in the veterinary context. We suggest that this ‘middle road’ should be reflected in professional veterinary guidance.     

Justice at risk! An evaluation of a pseudoscientific analysis of a witness’ nonverbal behavior in the courtroom

Psychology and law have developed as disciplines through rigorous data collection, exploration and analysis, and the publication of findings through peer-review processes. Such findings are then used to implement evidence-based practices within a variety of settings. However, in parallel to factually and scientifically based knowledge, ‘alternative’ science, or pseudoscience, has gained in popularity. The present case study aims to evaluate the empirical evidence and theoretical underpinnings of a publically accessible analysis of a suspected serial killer’s nonverbal behavior during a bond hearing published online by two ‘synergologists’. The case study emphasizes how a ‘synergological’ analysis to understanding and interpreting human behavior fails to use empirical data, making generalized inferences based on erroneous assumptions. The case study also highlights the detrimental effects such assumptions may have within the justice system and why pseudoscientific analytical approaches should be vigorously challenged by research scientists.     

Fatal Ingestion of Chlumsky Disinfectant Solution

A 32‐year‐old pregnant woman in the 25th week of pregnancy underwent oral glucose tolerance screening at the diabetologist's. Later that day, she was found dead in her apartment possibly poisoned with Chlumsky disinfectant solution (solutio phenoli camphorata). An autopsy revealed chemical burns in the digestive system. The lungs and the brain showed signs of severe edema. The blood of the woman and fetus was analyzed using gas chromatography with mass spectrometry and revealed phenol, its metabolites (phenyl glucuronide and phenyl sulfate) and camphor. No ethanol was found in the blood samples. Both phenol and camphor are contained in Chlumsky disinfectant solution, which is used for disinfecting surgical equipment in healthcare facilities. Further investigation revealed that the deceased woman had been accidentally administered a disinfectant instead of a glucose solution by the nurse, which resulted in acute intoxication followed by the death of the pregnant woman and the fetus.