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The purpose of this paper is to determine whether some aspects of the distinctive Mayo Clinic care model could be translated into English National Health Service (NHS) hospital settings, to overcome the fragmented and episodic nature of non-emergency patient care.

The authors used a rapid review to assess the literature on integrated clinical care in hospital settings and critical analysis of links between Mayo Clinic’s care model and the organisation’s performance and associated patient outcomes.

The literature directly concerned with Mayo Clinic’s distinctive ethos and approach to patient care is limited in scope and largely confined to “grey” sources or to authors and institutions with links to Mayo Clinic. The authors found only two peer-reviewed articles which offer critical analysis of the contribution of the Mayo model to the performance of the organisation.

Mayo Clinic is not the only organisation to practice integrated, in-hospital clinical care; however, it is widely regarded as an exemplar.

There are barriers to implementing a Mayo-style model in English NHS hospitals, but they are not insurmountable and could lead to much better coordination of care for some patients.

The study shows that there is an appetite among NHS patients and staff for better coordinated, multi-specialty care within NHS hospitals.

In the English NHS integrated care generally aims to improve coordination between primary, community and secondary care, but problems remain of fragmented care for non-emergency hospital patients. Use of a Mayo-type care model, within hospital settings, could offer significant benefits to this patient group, particularly for multi-morbid patients.

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended.

The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.’s “receptive contexts for change” and four of the eight factors stood out as especially important and form the basis of the paper.

The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very same pressures. Yet, despite having an enormous influence on health policy, the political context is frequently avoided in research or not regarded as instrumental in determining the outcomes in respect of transformational change.

The chief limitation is the credibility and authenticity of the interviews captured at particular points in time. These formed the datebase for subsequent analysis. The authors sought to guard against possible bias by supplementing interviews with observational studies and focus groups as well as running two dissemination events at which emerging findings from the study were subjected to independent external scrutiny and comment. These events provided a form of validation for the key study findings.

The research findings demonstrate the importance of context for the likely outcome and success of complex transformational change initiatives. These require time to become embedded and demonstrate results especially when focused on changing culture and behaviour. But, in practice, allowing sufficient time during which the organisation may remain sufficiently stable to allow the change intervention to run its course and become embedded and sustainable is highly problematic. The consequence is that bold and ambitious efforts like the NETS are not given the space and stability to prove themselves. Too often, politics and external environmental pressures intrude in ways that may prove dysfunctional and negative.

Unless a different approach to transformational change and its leadership and management is adopted, then changing the NHS to enable it to appear more responsive to changing health care needs and expectations will remain a cause for concern. Ultimately the public will be the losers if the NHS remains insensitive to changing needs and expectations. The patient experience was at the centre of the NETS programme.

The study is original insofar as no other has sought to evaluate the NETS independently and over a reasonable time period. The research design, based on a mixed-methods approach, is unusual in evaluations of this nature. The study’s conclusions are not so original but their value lies in largely confirming and reinforcing the findings from other studies. It perhaps goes further in stressing the impact of politics on health policy and the negative consequences of constant organisational change on attempts to achieve deep change in the way the NHS is organised and led.

A history of twentieth‐century censorship. Shakespeare's company staged the first production of The Merchant of Venice sometime between 30 July 1596 and 22 July 1598. From the day of that presentation, it is probable that the play has annoyed, perhaps even offended, many who have seen or read it, the source of the offense being the disparaging portrait of a major character, Shylock. On the stage for many years, there have been radically discrepant interpretations of the Jewish usurer. Since the day of Sir Henry Irving, actors and directors have often chosen to present Shylock in a way that transforms the role from that which Elizabethan playgoers may have seen and heard, or may have thought they had seen and heard, to the complex, ambivalent personality depicted in all productions since Irving first projected Shylock as a tragic hero.

Within the past few years, responsible educators, librarians, parents, counselors, social workers, therapists, and religious groups of all sexual persuasions and lifestyles have recognized the need for readily available reading material for lesbian and gay youth. Unfortunately, this material is often buried, because it is embedded in larger works. To meet this need, I have compiled and annotated 100 of the best works for young homosexuals, bisexuals, and heterosexuals. I have also included a few of the best works currently available on heterosexuality as a much needed source of knowledge for all young adults whether they are gay or straight, whether they remain childless or eventually become parents.

THE pre‐occupation of the moment is naturally the work of the Public Libraries Committee of the Board of Education. Its Questionnaire has been widely issued, and has been variously criticised. One or two authorities, including Wandsworth, have declined to furnish replies on the ground that they object to any disturbance of the present local control of libraries. The objection is a sound one, no doubt, although even that point is controversial, but we deprecate the attempt to anticipate the attitude and findings of the Committee. There is as yet no adequate reason to suppose that the Board of Education contemplates any national control of libraries which shall remove them from the keeping of their present authorities. There are many other ways, however, in which reforms are necessary and urgent, and these can only be brought about or even be considered in the light of comprehensive and accurate information. The refusal to supply information is, in any case, an ostrich‐like policy, since, if the Board of Education has determined that they will take over the control of public libraries, the objections of a local authority here and there will not alter that policy. We do not believe, however, that such a change is contemplated, and, in any case, it could only come about by a general agreement on the part of local authorities to that effect.

The management of children′s literature is a search for value and suitability. Effective policies in library and educational work are based firmly on knowledge of materials, and on the bibliographical and critical frame within which the materials appear and might best be selected. Boundaries, like those between quality and popular books, and between children′s and adult materials, present important challenges for selection, and implicit in this process are professional acumen and judgement. Yet also there are attitudes and systems of values, which can powerfully influence selection on grounds of morality and good taste. To guard against undue subjectivity, the knowledge frame should acknowledge the relevance of social and experiential context for all reading materials, how readers think as well as how they read, and what explicit and implicit agendas the authors have. The good professional takes all these factors on board.

“All things are in a constant state of change”, said Heraclitus of Ephesus. The waters if a river are for ever changing yet the river endures. Every particle of matter is in continual movement. All death is birth in a new form, all birth the death of the previous form. The seasons come and go. The myth of our own John Barleycorn, buried in the ground, yet resurrected in the Spring, has close parallels with the fertility rites of Greece and the Near East such as those of Hyacinthas, Hylas, Adonis and Dionysus, of Osiris the Egyptian deity, and Mondamin the Red Indian maize‐god. Indeed, the ritual and myth of Attis, born of a virgin, killed and resurrected on the third day, undoubtedly had a strong influence on Christianity.

We propose that the ambiguity of discourse around a category – rather than being problematic – improves the longevity of that category. This is especially true in the creative industries. Using methods and theories drawn from sociology and art history, we tested this thesis using swing as a case study. Based on three years of archival research we found 70 co-existing definitions of swing and 89 different uses of the term. These multiple meanings enabled various understandings to come in and out of focus over time, contributing to swing’s longevity. Our findings extend to other categories within the creative industries.