This thesis contains five studies that in different ways investigate poverty and the relation between poverty and exposure to crime. The basis of the thesis has been the question of how poverty is related to other welfare problems such as unemployment and health problems, focusing on exposure to crime and fear of crime. The thesis also has a comparative element. In one article, the conditions in Britain, Finland and Sweden are compared, and two articles compare conditions in Britain and Sweden. Poverty has been measured as relative deprivation. This is done by measuring consumption of socially perceived necessities, both goods and activities. For poverty to be at hand, not consuming some of the goods or not engaging in some of the activities must be a consequence of lack of economic resources, not of personal preference. The relation between poverty and exposure to crime has been understood from an interactionist perspective, where the possible interaction between and intersection of potential offender and potential victim constitute the determinant factor for the risk of being exposed to crime. In this perspective, the poor are more exposed because their situation of being poor places them in situations where the risks of being exposed are high. Fear of crime stems from different sources. The significance of earlier victimization, the characteristics of the geographical unit where one lives and vulnerability in the event of actual exposure have been investigated. It was found that poverty measured as relative deprivation is related to other welfare problems, primarily other economic problems, unemployment, health impairments, anxiety, sleeping problems and headaches. But it was also found that poverty is related to exposure to crime and fear of crime. Furthermore, poverty based on an income measure did not correlate especially well with other welfare problems. It was also found that the extent of poverty measured as relative deprivation is equal in Britain and Sweden, while it is more extensive in Finland. This result contradicts earlier studies based on income measurements of poverty, which show that poverty is about equally common in Sweden and Finland and more extensive in Britain. It was found that the reason why relative deprivation is more extensive in Finland is that the level of unemployment is higher there and that the unemployed are worse off in Finland than in Britain and Sweden. Regarding the relation between poverty and exposure to property crime, it was found that the poor are more exposed than are the non-poor with regard to the property crime that violates personal integrity most: property crime related to the residence. Exposure to crime was found to be more of a poverty problem in Sweden than in Britain. Because crime rates are about equal in Britain and Sweden, the result indicates that the risk of being exposed to crime in Britain is more equally distributed across the population. Furthermore, it was found that fear of crime in Sweden is related to poverty, while fear of crime in Britain is more related to vulnerability in general, particularly vulnerability on the labour market. One reason for this may be that fear of crime is more common in Britain than in Sweden. Fear of crime may be such a general problem in Britain that the poor cannot be differentiated from the non-poor.

This study explores the challenges faced by Principal Stakeholders in achieving Scotland's strategic approach to health and social care integration. This is a developing area for academic literature, limited to, but not devoid of the experiences of integration of specific public sector areas and the experience of other countries that have implemented an integrated approach. The research studies the views and opinions of 12 Chief Officers from three areas of public sector provision; the Scottish Government, Heath Boards and Local Authorities to elicit their initial fears and concerns, approaches and development. This qualitative research approach provided a richness and depth of data which is presented within the thesis. The evidence gathered informed the design of the influencing factors and a conceptual model for health and social care integration and importantly for future integration models which may be applied to future projects. It is concluded from this study that health and social care integration while challenging, is achievable through a planned approach when considering the key influencing factors. The factors, are flexible depending on the stage of integration and the priorities of the Integration Board, and therefore should be used accordingly. The development of the factors would not have been achievable without the considerable input of the participants involved. The key contributions of this research span across academic literature, research methodology and professional practice. The study contributes to the current research considerations by developing an approach based on the work undertaken by the professionals and learning from the unintended consequences of the experiences of such early intervention. Finally, the influencing factors and conceptual model are offered as evidence of the research undertaken as a contribution to practice. The value to academics, practitioners and the wider public service and agencies involved in integration lies in the frameworks contextual factors and ultimately the flexibility of application.

Younger People with Dementia (YPwD) are those who receive a diagnosis of dementia under the age of 65. In Scotland the number of people with dementia who meet this definition is approximately 3200 (Alzheimer Scotland, 2017). The purpose of this study was to explore the human experience of living with dementia at a younger age and to consider interpretations of well-being as defined by the subjective experience of the participants. At the start of this study there was limited quality research available which explored the lives and experiences of YPwD. At that time there was some recognition within professional groups and practitioners that YPwD would benefit from age appropriate services. This study used an Interpretive Phenomenological design to explore the experiences of YPwD and used in-depth qualitative interviews with eight people who were diagnosed with dementia under the age of 65, to capture their journey through pre-diagnosis, diagnosis and beyond. Interpretive Phenomenological Analysis was utilised for the primary analysis. A secondary analysis was then conducted with the initial findings using Self-determination Theory, Basic Psychological Needs Theory, autonomy, competence and relatedness to identify areas of well-being. The study identified four superordinate themes situated within a four phase transition pathway, which identified how a diagnosis of dementia impacted on the person and the process they underwent following diagnosis. These are:pre-diagnosis phase, living in a changing world, awareness of the changing self, discombobulation; diagnostic phase, anger and relief, the fragmented self, consideration; post diagnostic phase, the challenge of learning to livewith dementia as a younger person, the evolving self, assimilation; and the phase living well beyond dementia, consolidated self, consolidation. The study highlighted that while having a diagnosis of dementia at a younger age is a challenging and devastating experience, it is possible to live a good and productive life beyond the diagnosis of dementia. The secondary analysis using Self-determination Theory, Basic Psychological Needs Theory identified that where the basic psychological needs were supported, this enabled participants to embrace their lives living with and beyond dementia with improved wellbeing. The findings suggest that the basic psychological needs were thwarted in the pre-diagnostic phase and during and immediately after diagnosis, creating feelings of ill-being. The study acknowledges the strong sense of identity around the younger person with dementia and suggests that this group perceive their dementia, and the support they need to live with the condition to be a different experience to that of older people. The ability of a number of the participants to live an active life within a supported community cannot be underestimated, and suggests that this area of care and support needs to be evaluated in light of the changing needs of people living with dementia, particularly those who are diagnosed at such an early part of their lifecycle.

The overarching aim of this thesis is to critically evaluate the implementation of Lean in NHS Lothian, a National Health Service (NHS) Health Board in Scotland. Against challenging financial times, Lean has been endorsed for adoption in the provision of healthcare by The Scottish Government and NHS Scotland and so the objectives are to understand how Lean is implemented in healthcare, the impact on the organisation and what role(s) are held by front-line staff including medical staff, in this implementation. This is an exploratory and descriptive interpretivist case study incorporating content analysis, observational and interview data which is based on a qualitative and inductive approach. The interpretative and inductive nature of the research is used to identify emergent themes and to afford greater insight into the implementation process, outcomes and the role of healthcare staff. The sociology of professions is used to evaluate the role of the medical professional within Lean from the emergent data, with the focus being on behaviours expected and demonstrated in Lean implementations. The findings provide a mapping of the process for implementing Lean. It is also demonstrated that although medical professionals are expected to hold a crucial role in Lean implementations, their identity as a professional with corresponding power and autonomy provides challenges for implementing Lean in hierarchical areas such as healthcare. This professional identity also impacts on project initiation and sustainability as other stakeholders recognise hierarchical constraints. However, evidence grounded in the data illustrates that Lean breaks down hierarchies and has resulted in improved working in services. The implementation of Lean has been programmatic in line with best-practice case examples and has been driven by strategy and target pressures faced by services. This research provides a contribution to knowledge in three key areas: firstly through mapping the approach to Lean implementation which is a contribution to Programme Theory. Secondly medical professionals are explored through the lens of professionalism which has received limited attention to date within Lean; and finally a set of propositions are generated as a framework for Lean implementation in healthcare.