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Addresses the issue of the adoption of generic drugs by general medical practitioners in the National Health Service in England. The adoption and buyer behaviour of GPs is of central importance to the pharmaceutical industry and to the Government. Reports research based on the theories of perceived risk and work simplification, set in the context of the growing pressure on doctors to contain total prescribing costs. Based on the findings of in‐depth research interviews with 39 GPs, concludes that perceived risk on the part of the GP is a significant determinant of generic drug adoption and that the desire to simplify work load decisions is also important.

After great Wars, the years that follow are always times of disquiet and uncertainty; the country is shabby and exhausted, but beneath it, there is hope, expectancy, nay! certainty, that better times are coming. Perhaps the golden promise of the fifties and sixties failed to mature, but we entered the seventies with most people confident that the country would turn the corner; it did but unfortunately not the right one! Not inappropriate they have been dubbed the “striking seventies”. The process was not one of recovery but of slow, relentless deterioration. One way of knowing how your country is going is to visit others. At first, prices were cheaper that at home; the £ went farther and was readily acceptabble, but year by year, it seemed that prices were rising, but it was in truth the £ falling in value; no longer so easily changed. Most thinking Continentals had only a sneer for “decadent England”. Kinsmen from overseas wanted to think well of us but simply could not understand what was happening.

Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.

Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.

The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.

Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.

This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.

The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.

The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.

This study aims to investigate how institutional and organisational factors affect case management of patients with mental disorders by GPs in Italy and Spain. The paper highlights the importance of improving the effectiveness of primary care to ensure easy access to mental health services, which is crucial in responding to the increasing incidence of mental disorders and preventing negative outcomes.

This article details a qualitative research study that examines the management of patients with mental disorders by general practitioners (GPs) in Italy and Spain, using cross-national comparison and in-depth interviews with GPs as research methods.

The study revealed that Italian self-employed GPs have more scheduling autonomy than Spanish Health Centre GPs. Both face high work pressure and resource scarcity, highlighting the need for targeted training. The COVID-19 pandemic led to a rise in phone consultations.

This study provides novel insights into mental health management by examining the case management of patients with mental disorders by GPs in Italy and Spain, with a focus on the impact of institutional and organisational factors. The cross-national comparison and in-depth interviews enhance the originality of the study, offering a nuanced understanding of the constraints faced by GPs in their work context. Furthermore, the comparison of the similar primary care frameworks of Italy and Spain may offer insight into their evolution.

The purpose of this paper is to answer the question: in the British state's relationship with its diverse minority ethnic communities, how have politics framed administrative allocation of language support services? The dynamics of policy development are investigated, a tangible effect of the shift from unofficial pragmatic multiculturalism towards community cohesion/“Britishness” having been a government focus on English for speakers of other languages (ESOL) rather than translation/interpreting. This change has revealed a tension between the demands of identity and equality for minority ethnic people: respect for cultural identity requires provision of translation/interpreting while creating (political) equality between majority and minority communities entails the latter having access to the political language so placing an emphasis on ESOL.

An evidence synthesis is undertaken of policy documents relating to the British state's provision of language support services and data on the skill levels in English from government surveys.

The relative contribution of financial constraints and new policy/ideological positions to changes in the direction of policy and provision is assessed. With respect to the “new approach to ESOL”, this process of discretionary allocation that privileges policies of integration and community cohesion rather than language need itself is viewed against the inadequacies of the data currently available on levels of English language proficiency in providing the basis for making policy decisions and allocating resources.

The level of English language skills amongst Britain's minority ethnic groups and of government policy to address skill deficits has been substantially neglected. The paper provides a policy focus ahead of the release of the 2011 Census findings on language questions.

For leadership and management of Western health systems, good quality relationships are a fundamental cornerstone of organising health and social care (H&SC) delivery, delivering benefits across organisations and communities. The purpose of this paper is to explore the extant management, H&SC literature, grounded in older people care, reveal behaviours, processes and practices that if readily identified across a context will support healthy relationships across the “whole system” of stakeholders.

An academic/practitioner group designed and guided a scoping literature review of the H&SC and broader management literature to identify and extract important behaviours, processes and practices underlying the support of high-quality relationships. A search strategy was agreed and key health and management databases were interrogated and 51 papers selected for inclusion. Working with the practitioners, the selected papers were coded and then organised into emergent themes.

The paper outlines the relational behaviours, processes and practice elements that should be present within an older peoples care community, to support a healthy relational environment. These elements are presented under the five emergent literature themes of integrity, compassion, respect, fairness and trust. These five topics are examined in detail. A way forward for building statements using the review material, that may be applied to reveal relational patterns within older people care, is also explored and outlined.

All literature reviews are subject to practical decisions around time, budget, scope and depth restraints. Therefore potentially relevant papers may have been missed in the review process. The scoping review process adapted here does not seek to make any major considerations with regards to the weighting of evidence behind the primary research.

This paper contributes to a growing need for designers of health systems to more fully understand, measure and draw on the value of relationships to help bridge the gap between diminishing resources and the expanding demand on H&SC services.

The purpose of this paper is to present findings from a mixed-methods study on the impact that COVID-19 has had on adult safeguarding. The research sought to explore the challenges and opportunities presented by COVID-19 to both frontline and non-frontline professionals working in adult safeguarding.

A mixed-methods project was undertaken comprising a literature review, survey, semi-structured interviews and a small number of freedom of information requests. This paper presents the findings predominantly from the survey and interviews.

Unsurprisingly, COVID-19 has presented a variety of challenges for professionals working in adult safeguarding. The themes that occurred most often were the day-to-day changes and challenges, relationships across sectors, information and navigating the ethical questions in safeguarding.

To the best of the authors’ knowledge, the findings represent the first focused qualitative mixed-method study aimed at understanding more about the impact the pandemic has had on adult safeguarding through the eyes of those professionals working in that field.

Structural engineering as a part of civil engineering has over 5,000 years of distinguished history, as documented in this paper. An attempt is made in this paper to define structural engineering as it exists at present, then some historical structures are identified.

The advances of structural engineering are discussed in chronological order, encompassing the development of the concept, analysis, the use of innovative construction materials, and construction. The developments which necessitated the change of design philosophies are presented, and the current status of structural engineering is discussed in terms of several specific topics. Opportunities and challenges in the new millennium in structural engineering are then presented in terms of education, service to society, and research.

In the past, structural engineering always met the challenges it faced. It helped to improve our quality of life, and its role in society is not expected to change in the near future.

The paper has provided an over‐view of this important profession – from ancient history to the present day. Based on research over several decades it offers a prediction of the direction in which this profession and the academic research that underpins it is likely to take in the future.

This paper aims to present examples of historical British antecedents of innovative construction procurement, project organisation and social structures, through an historical case study and highlight how contemporary innovative “newness” can sometimes be preceded by historical antecedents.

This paper used informal analysis of extant literature and historical archives, to synthesise those antecedents presented and reflect on these in light of contemporary construction practice and innovation.

The case study project, capturing the period c.1894-1904, demonstrates numerous historical but significant innovations relating to project organisation and social structures. The extent of these may result from more lax regulation and workplace controls of the time. The case also epitomises how a publicly accountable authority, can realise a high-quality, constructed product in good time, using direct labour and without recourse to competitive procurement.

The blending of historical construction research with contemporary construction innovation (CI) thinking may open new academic opportunities in both fields.

The findings suggest that a less regulatory-constrained environment appears conducive to incremental and process-oriented CI activity.

There is a dearth of construction history research; its application to CI is unique.