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Childminding is popularly characterised as childcare in a home-like environment. In the wake of the National Childcare Strategy, and with an emphasis on childcare 'quality', the state is increasingly constructing childminders as Early Years Professionals who happen to work in their own homes. This thesis is an attempt to explore registered childminders' negotiation of the meaning and practice of their work in the context of contemporary developments in childcare policy. It is based on ethnographic fieldwork conducted in an Inner London Borough (2003 - 2005). Methods employed ranged from participant observation, the collection of ephemera, interview and sorting exercises, to the improvisation of the raffle as a research technique. Following consideration of the social and historical context of childminding's popularity, the thesis explores some of the varied meanings that childminders bring to and gain from their work. Focussing on the spatial, social and temporal dimensions of the home environment it examines in ethnographic detail the qualities and negotiations that characterise childminders work betwixt and between 'private' and 'public' domains. Childminders’ performance of professionalism is explored and some ways in which women negotiate tensions between internal beliefs and external demands in this context are considered. It is argued that in their encounter with the 'technology of quality' childminders are reproduced as deficient. Tradeoffs associated with childminders' engagement with the hegemonic model of professionalisation are shown to have continuities with broader feminist debates over equality/difference and care/justice. It is suggested that childminders' work is characterised by the negotiation of contradictions. Informed by and hoping to inform a focus in feminism on the empirical study of care work, the thesis also hopes to contribute toward a growing anthropology of public policy as well as to add childminders' perspectives to the burgeoning critical reappraisal of the hegemonic mode of professionalisation in the Early Years.

This thesis is concerned with the development and evaluation of the collaborative care model for the treatment of depression in primary care in the National Health Service (NHS). It begins with an outline of the problems experienced by people with depression and the challenge that their effective care presents to the healthcare system. It then considers the response of evidence-based medicine to this challenge and briefly reviews the commonly used tools of evidence-based medicine (such as systematic reviews and clinical guidelines). The origins of the collaborative care model in the treatment of chronic physical health problems are then reviewed to provide a context for a subsequent review of the current evidence for collaborative care for depression. Following this review the main elements of the effective treatment of depression are examined and include systematic reviews of the major psychological and pharmacological treatments. The competences required to deliver low-intensity brief psychological interventions are also developed and described. The design, implementation and evaluation of an exploratory trial of collaborative care of depression are then described and set in an overall framework for the evaluation of complex interventions as outlined by the Medical Research Council. The outcomes of the trial and a parallel process evaluation are then presented and the limitations of the trial considered. The implications of the trial for the future development and evaluation of collaborative care in the NHS are discussed.

Throughout New Labour’s term in office, from 1997 to 2010, the Government placed increasing emphasis on both healthy policy and regionalism. No longer was health merely part of the National Health Service agenda. Instead, all policies had to take health into account, to address the wider determinants of health, such as housing, employment and poverty. New regional agencies were created to aid policy development and implementation at the regional level. This study considered the way healthy public policy reached and climbed the decision-makers’ agendas within these regional structures. The North East region of England was chosen as a case study. A series of interviews took place with those most heavily involved in policy-making in the region. Documents from the regional agencies and other organizations playing a part in the decision-making process were examined. Along with general policy, four specific policy areas were investigated: tobacco control, housing, worklessness and climate change. These were chosen to allow comparison of influential factors, particularly those factors identified in the agenda-building literature. Several agenda-building models proved helpful, suggesting factors shown to influence agendas, although many related to national agendas. The most significant factors were the people and organizations involved and the ways they worked together, formally and informally, across departments and across organizations. Informal joint working was also particularly useful in enhancing decision-makers’ awareness of health issues so that health would be considered in all policy. The recently elected Government plans to move away from regionalism towards localism. The North East currently has an ethos of joint working and a commitment to healthy policy. Losing the supportive regional structures could well mean losing the capacity to make all policy healthy policy.

The aim of this study was to design and implement a non-smoking policy at a university and to recommend health promotion interventions based on die transtheoretical model and employee interest. A combination of qualitative and quantitative research methods was used. A questionnaire was sent to a random sample of employees (N=641) to assess smoking habits, nicotine dependency, intention to quit, perception of norms, daily exposure to environmental tobacco smoke, and attitudes towards a non-smoking policy. To complement the survey data gathered, measurements of particulate matters and benzene were taken in several locations at the university. In addition, eight focus group discussions took place with a purposive sample of employees seeking positive ideas for implementing a successful policy, and reasons for their objection. A response rate of 70.4% was obtained from 578 eligible employees. Survey results suggest that 25.7% university employees smoke. The majority of respondents supported a restrictive non-smoking policy (81.7%). Acceptance among active smokers was significantly lower (59.2% vs 89.3%). Smoking prohibition with the provision of smoking areas was the most favoured option (46.9%). Lack of compliance and the presence of persistent smokers were seen as potential obstacles for the implementation of a non-smoking policy. Most of the smokers (73.6%) presented a low level of nicotine dependence. The application of the transtheoretical model of change to the sample under study suggests that the majority (59.6%) of smokers at the university were not considering quitting in the near future. Interest in availability of smoking cessation activities differed by stage of change. Based on this research a non-smoking policy has been implemented at the University of Navarre. This project could result in an improvement on die future health of 1,900 university employees and 12,000 students. There is great potential for learning from this experience and for applying it to other settings where tobacco control efforts are needed.

This thesis is concerned with the health-related quality of life of two groups of refugees and asylum seekers from the Democratic Republic of the Congo, who are resident in Britain and France. Drawing on theories of health inequalities and psycho-social stress, the thesis argues that the health-related quality of life of refugees and asylum seekers is mediated by their immigration and citizenship status. Introductory chapters set the scene for the study, giving consideration to patterns of immigration and the emergence of minority ethnic groups in Britain and France, thus setting the context for the arrival and reception of refugees and asylum seekers during the 1990s. Citizenship, health inequalities, and the existing knowledge concerning the health of refugees and asylum seekers are addressed. Qualitative research, informed by phenomenology, is used to explore the health-related quality of life of these refugees and asylum seekers. The findings are presented and discussed in three chapters in the body of the thesis. Problems with psychological health dominate the findings; issues relating to physical health are presented largely within the context of seeking access to health care. A fourth chapter critically interprets the findings and locates them within wider literature. The thesis concludes that the health-related quality of life of refugees and asylum seekers is affected by their immigration status and by their lack of citizenship in their host countries. In the absence of citizenship of either Britain or France, refugees and asylum seekers are located in hierarchical societies, characterized by civic stratification, which confers a different set of rights on citizens, refugees and asylum seekers. Asylum seekers have fewer rights than refugees, who, in turn, have fewer rights than citizens. This thesis suggests that these relative statuses contribute to psycho-social stress and thus the health-related quality of life of refugees and asylum seekers.

This study examined the possibilities of empowering people of a range of severity of dementia, by eliciting accurate views and feelings from them about services and including them in service evaluation. The study was underpinned by a four tier empowerment framework, which incorporated issues relating to the individual, the organisation, the service user and society. An ethnographic approach to data collection and analysis was employed. Twenty-seven people with dementia from Jewish Care residential and day care settings were interviewed and their daily lives videotaped and observed and interviews conducted with next of kin. Efforts were made to empower and involve participants in the research process as far as possible. Triangulation of interview, video and observational data reveal that with appropriate methods and skills it is possible to elicit accurate information from people in various stages of dementia, and thereby involve them in service evaluation. A number of techniques for communication are highlighted. Findings also show that although relatives' views are frequently taken as proxy for those of people with dementia, they may lack knowledge about services and the perceptions of people with dementia. In residential care their views differed considerably to those of people with dementia, suggesting that is important to consult with the person with dementia themselves. The data suggest that the experience of dementia was disempowering for both people with dementia and their relatives. In addition, although day care services were perceived more positively, people with dementia were disempowered by a lack of influence, control, communication and social aspects of care in residential settings and relatives by a lack of support and information in the community. Although participants were of Jewish origin and from Jewish settings only, it is considered that the results are more widely applicable to other groups of people in other settings. A number of recommendations are made about creating a more empowering workforce and environment and a model of empowerment for dementia research and practice is outlined.

This thesis is a study of current pension policy and its likelihood of providing a decent retirement income that guarantees a quality of life for the low paid, namely a retirement above subsistence level and one that offers them dignity and personal autonomy. The low paid often experience financial difficulties during their working lives and owing to competing financial demands not only do they struggle to make ends meet but find it difficult to put aside savings for their futures. This research was a social investigation and examined current government thinking and its approach to redress these problems. It used a multi-methodological approach underpinned by four components: a literature review; a comprehensive analysis of research reports that focused on individuals' saving habits; semi structured interviews with the low paid to explain their real life experiences; and an analysis of contemporary proposals. The literature review highlighted that since the 1950s there has been a shift from socialisation of risk, where risk is shared by the state employer and employee, to an individualisation of risk in pension policy and 'New' Labour has continued along this route. Moreover, low pay remains a prominent issue today just as much as it did at the beginning of the 20th century. It is this combination of continued low paid and increased risk on the employee that has exacerbated the plight for many in low pay employment. The current solution supported by government relies on using means testing to protect the poorest whilst expecting others to be 'responsible' citizens and provide for their retirement under the rhetoric of 'rights' and 'responsibility'. Yet as this research established many in the latter category are considered low paid by the Low Pay Unit. It is this problem of definition that has led policy makers to fail to understand that the low paid are in fact unable to make money purchase pension schemes viable. This has now been recognised by other organisations, political parties and academics. Now even the pro-market right have acknowledged the failure of the private sector to bridge the gap vacated by the state under twenty years of neo-liberal policy and argue that means testing, once favoured by the Conservative Party, acts as a disincentive to save towards a second-tier private pension. Key findings in this thesis include: first that the low paid do in fact have a positive attitude towards saving but it is their lack of ability and real opportunity that prevents them from saving towards a decent second-tier pension. Thus there is a contradiction in policy that seeks to improve attitude and awareness of the low paid to improve their situation. Second, that the government presides over a low paid economy and this is a political choice that favours pro-business labour market policies. Third, current government attitude continues to ignore the warnings from both pro-state left and pro-market right sources that a continuation of a pension policy relying on means testing in fact acts as a poverty trap. And finally, the plight of the low paid remains bleak and will worsen in the future if neo-liberal policy continues without increased state intervention.

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