In response to the Social Exclusion Unit's Policy Action Team 10 (1999), Sport Action Zones (SAZs) were launched in 2000 as Sport England's attempt to create an effective and sustainable sporting infrastructure in areas of high economic and social deprivation, ensuring more equitable participation in sport (Sport England, 2003a). Such an initiative was supported by the firm belief that although sport and physical activity could not in themselves prevent or eradicate social exclusion (Pitter and Andrews, 1997), they were one potential means of positively affecting health, education and crime (PAT 10, 1999; Farrell and Shields, 2002; Sandford et al., 2006). It is essential to adopt a holistic approach that concentrates on those problems experienced by individuals engaged in a physical activity intervention (the context), rather than the intervention itself. This is a consequence of the fact that any quest to abolish dimensions of social exclusion will involve a plethora of complex associations and factors which create a myriad of outcomes (Coalter et al., 2000). Using hybrid grounded theory as the theoretical underpinning, this study investigated over three years (2002-2005) the implementation of four projects within the Wear Valley SAZ in the north-east of England: Walking the Way to Health; Community Physical Activity Coordinators; Positive Futures; Modem Apprentices. Adopting an internal relative ontology and a subjective epistemology, case study methodology was employed in conjunction with participant observation, questionnaires, focus groups and interviews. Key themes emerged from the qualitative analysis of data, facilitating a deeper understanding of the strengths and weaknesses of the Sport Action Zone, and of the individuals who engaged with it. The Wear Valley SAZ was seen to positively impact upon health, education, and crime. Nevertheless, the extent of this contribution to social inclusion was limited as it failed to adequately engage with those at greatest risk of social exclusion. Sport Action Zones have the potential to contribute significantly to social inclusion in areas of high socioeconomic deprivation, but this impact will be determined by the extent of consideration given to both the context within which the intervention is to exist and the potential mechanisms responsible for change. Moreover, to be successful, any such intervention must (at the design stage) be cognisant of the interrelationships between: physical activity determinants, notions of empowerment, attitude towards physical activity, and sustainability of participation. These are fundamental intervention precursors required to maximise those positive impacts upon health, education, and crime. Furthermore, as the complexity of the multiple risk factors associated with social exclusion inevitably lead to delays in affecting significant change, allowing time to address individual risk factors will increase the probability of creating a more effective and sustainable sporting infrastructure, particularly in areas of high socioeconomic deprivation.

The subject of child support is one that crosses the boundaries of many academic disciplines, not least public and social policy. The formation of effective child support policy and the efficient implementation are fundamental requirements in order to sustain a fair and workable system for the provision of financial maintenance for children after the separation of their biological parents. This study considers the combination of changes brought about by the themes of new public management in the introduction and implementation of a controversial child support policy and the subsequent execution of child support legislation by the Child Support Agency. The emphasis is made on the Child Support Agency as a Next Steps Agency in analyzing its internal organization and operational performances within the themes of new public sector management. In this study comparisons are made between what child support policy was intended to achieve under the principles of new public sector management and the actual outcomes that have been realized

This thesis has two principal aims. The first is to understand why change oriented towards improving the coordination of care for long term users of healthcare (and related) services is so difficult to achieve. The second is to identify possibilities for how these difficulties may be overcome. During the three-year period 2002-2004, two NHS Trusts instituted a particular means for coordinating care, integrated care pathways (ICRs), as 'the way that clinical work is done here'. These change efforts were instigated as part of a collaborative NHS modernisation project. Despite similarities between the Trusts and their change programmes, the organisational outcomes from the modernisation project differed. This thesis identifies factors that contributed to these differing outcomes. The research was framed within an organisational perspective drawing upon recent organisational theory and a relevant research approach; interpretative structuralism. This approach used a variety of research techniques (historical analysis, document review, surveys and interviewing) to examine the social contexts underpinning prevailing thinking within the NHS about how clinical work should be organised and managed. The results showed that many factors in the wider context of the NHS and the local clinical 'shop floor' operate to fragment thinking about how care should be organised. In one Trust several factors contributed to its greater success in implementing ICRs. These included (i) coherence and congruence amongst the senior management in conceptualising and pursuing more product oriented approaches to clinical management, (ii) clinically led services and devolution of authority, (ііі) a willingness of all staff (including senior management and clinicians) to be self critical and thoughtful in making suggestions for improving clinical performance, and (iv) an ability by senior management to interweave five key themes in clinical service provision throughout the organisation. These themes were patient experience, service redesign, financial balance, the inter-relationship between these three, and integrated governance of the resulting organisational processes and outcomes. The results also showed that local contextual factors such as the character of the local electorate and the style and expected longevity of the senior leadership can undermine success in achieving agreed goals for coordinating and managing care.

Background- The purpose of this research was to understand the needs and preferences of young people who are labelled as “hard to reach” when it comes to the delivery of sexual health information. Up to this point, most research has taken the form of needs' assessment, or service or outcome evaluations; thus it has had a predominantly practical, problem-solution focus. This qualitative study was theoretically informed by and focused on achieving a deeper level of understanding by exploring the phenomenon under investigation rather than reporting on existing situations and offering solutions to problems. Method- Semi-structured interviews were carried out in London with 23 young people from both genders who were peer educators (11) and professionals (15) who were responsible for the design and delivery of the information to NEET young people. Main findings: Analysis of data showed that young peoples perceived needs for sexual health information was different to what the providers thought. Even peer educators, who were young people themselves and from the same socioeconomic backgrounds seemed to have different views from the 'hard to reach'. This could be that their social mobilization to become peer educators distanced them from the group they are serving. Their perceptions were more similar to the professionals than young people. The young people's perceptions of their needs fell into three categories: need for a significant other, need for help and need for information. This study sheds light on a marginalised group of young people who have not been studied before in such depth; it challenges the use of the label 'hard to reach' and offers a critique of current policy approaches. The thesis concludes with some recommendations, for research, policy, and practice with the aim of developing a more responsive service for young people.

The central focus of this thesis is managing change in the National Health Service (NHS). In particular it considers the introduction of general management into the NHS - its third major reorganization and one based on the recommendations of a team of businessmen led by Sir Roy Griffiths, then managing director and deputy chairman of Sainsburys foodstores. More than previous reorganizations of the NHS in 1974 and 1982, the Griffiths changes were a conscious attempt to move away from a "boxes and charts" approach to organizational change to one which sought to disturb organizational processes and ultimately to change the beliefs and values of NHS actors. The thesis attempts to illuminate the implications of what was viewed as a significant change in the way the NHS was managed, in three ways. Firstly it reviews the existing empirical work on health service management and considers what can be learnt about the difficulties of introducing change in the NHS. Secondly it reports fieldwork data from twenty NHS districts which explores the actions and priorities of twenty newly appointed DGMs with a variety of different occupational backgrounds as they sought to implement the agenda for change spelt out in the Griffiths Report. The thesis reports a significant gap between the aspirations of the Griffiths Report and what the introduction of general management was able to deliver and a number of unintended consequences. Thirdly the thesis draws on the work of Norbert Elias known as figurational or process sociology in an attempt to illuminate the fieldwork data further. Elias is not a sociologist one associates with the study of the NHS, or indeed the management of change, yet it is argued that his writings offer much to those wishing to explore organizational and management issues in the NHS.

No description available.

This project comprises a critical exploration and development of methods for the synthesis of evidence, using a chain of evidence approach, from diverse, yet inter-related, sources. The methodologies were explored through the development of a comprehensive decision model to assess different health policies in respect to screening for type 2 diabetes mellitus (T2DM). Four strategies were compared which were, no screening (current policy), screening for T2DM alone allowing for early diagnosis and treatment of the condition, and two strategies whereby both impaired glucose tolerance (IGT) and T2DM were screened for, allowing for early treatment of T2DM and for either lifestyle or pharmacological interventions to be applied to those with IGT in an attempt to delay the onset of T2DM. The comprehensive decision model developed here was innovative when compared to current published models in a number of ways. Firstly the entire model was encompassed within a single flexible framework, which has a number of advantages, and secondly as much of the available data as was feasible to use, was incorporated into the model inputs. A number of methodological issues and techniques were explored during the development of the comprehensive decision model. These included mixed treatment comparison analyses, assessment of baseline risk on intervention effects and the use of individual patient data. A number of sensitivity analyses and model extensions were carried out to assess the parameters with most influence on model results, and to adapt the model to different screening scenarios. The results of the model provide evidence that a screening strategy for IGT and T2DM, followed by appropriate treatment and interventions appears to be a cost-effective screening strategy. Uncertainty still surrounds the cost-effectiveness of screening for T2DM alone and further research is required. Running decision models within a Bayesian, comprehensive decision modelling framework, allows for model flexibility and has advantages over more conventional modelling techniques.

This study investigated the situation of street children in Zimbabwe with reference to the United Nations Convention on the Rights of the Child (1989). It examined the services that have been provided to meet street children’s needs and safeguard their rights. There is a dearth of literature focusing on street children in Zimbabwe. The available literature is descriptive; it contributes very little towards understanding of the problem and needs of street children. It does not provide a useful framework for formulating policy and designing interventions or practices with the children. Models being used by some non-governmental organizations derive mainly from studies conducted in Latin America and other developing countries like India, Kenya and South Africa. This study draws, mainly on literature from Latin America and other studies outside of Zimbabwe. Quantitative and qualitative data were gathered from street children and service providers, using a triangulation of methods. Ethnography was particularly useful as it allowed the project to adopt a child-centered approach. Interviews and group discussions were conducted with service providers. Documents from non-governmental organizations helped to understand their work with the street children. A breakdown of the extended family unit, poverty, HIV/AIDS, corruption and land reform have hindered the protection of children’s rights as prescribed by the United Nations Convention on the Rights of the Child. Zimbabwe has no mechanisms in place to enforce them. Although a range of difficulties plague projects for street children, some projects have succeeded in improving the well-being of some street children. Zimbabwe is violating the United Nations Convention on the Rights of the Child. It should seriously and urgently consider re-deploying its ‘welfare’ departments into ‘development ‘departments for it to realize the rights of street children.

The published articles from Appendix 6 are not available in the electronic version of this thesis due to copyright restrictions. The full version can be consulted at the University of Leicester Library.

Literature review. A systematic review of the literature on the effects of reminiscence on communication with people with dementia was conducted. The focus was the impact of reminiscence on communication and implications for care improvement. Reminiscence can potentially improve communication with people with dementia in several ways. Evidence was strongest for improvement in content of communication, following life review interventions. Research report. A qualitative study was carried out to explore the experiences of care staff delivering life storybook sessions to people with dementia. Eleven participants were interviewed, and Interpretative Phenomenological Analysis (IPA) used for analysis. Six themes were identified: Barriers to Personhood; Meeting the Person through Life Storybooks; Rehumanising the Person; Rehumanising the Professional; a Changed Relationship; and Plans for the Future. The starting context for many was a restrictive environment and a lost/hidden person. Participants were generally able to develop a more intimate connection with the individual person through delivering life storybook sessions. The experience seemed to rehumanise the person and the professional through the development of their relationship beyond formal staff-patient interactions. However, staff plans for future sessions tended to move away from that one to one relationship, perhaps to more effectively manage the complexity of the work. Links to literature on reminiscence, identity, social psychology and social defence systems are explored. Implications for clinical practice arising include involving care staff in delivering life storybook sessions, supported by clinical supervision. Areas for future research include evaluating changes in ward atmosphere and Dementia Care Mapping to explore care improvements from the care receiver perspective. Critical appraisal. An in depth account of the researcher‟s reflections on the experience of the research process is provided. Her personal contribution to design, procedure and analysis, and learning outcomes are explored.