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Multiple challenges remain in achieving sustainability of digital health innovations, with many failing to realise their potential due to barriers to research, development and implementation. Finding an approach that overcomes these challenges is important if society is to derive benefit from these new approaches to healthcare. Having been commissioned by local authorities, NHS Trusts, prisons, charities, and third sector providers across the UK, Breaking Free Group, who in 2010 launched Breaking Free Online (BFO), a computer-assisted therapy programme for substance misuse, have overcome many of these challenges. This has been possible through close collaborative working with partner organisations, to overcome barriers to implementation and sustainability. The paper aims to discuss these issues.

This paper synthesises findings from a series of qualitative studies conducted by Breaking Free Group in collaboration with health and social care charity, Change, Grow, Live (CGL), which explore barriers and facilitators of implementation and sustainability of BFO at CGL. Data are analysed using thematic analyses with findings conceptualised using behavioural science theory.

This partnership has resulted in UK wide implementation of BFO at CGL, enhanced focus on digital technologies in substance misuse recovery, and a growing body of published collaborative research.

Valuable lessons have been learnt through the partnership between Breaking Free Group and CGL, which will be of interest to the wider digital health community. This paper outlines those lessons, in the hope that they will provide guidance to other digital health developers and their partners, to contribute to the continued evolution of a sustainable digital health sector.

Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders’ perceptions around the upcoming smoking ban.

A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings.

Themes generated from the data were “freedom and rights”, “the prison environment” and “guiding support”. Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban.

Overall, it was apparent that participants’ awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders’ awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours.

This paper addresses some of the future challenges that the vote to leave the European Union (EU) may have on the UK’s constitutional framework. The potential abolition of the Human Rights Act 1998 and its replacement with a Bill of Rights is examined in relation to the interpretation of freedom of expression. More specifically, this is analysed in relation to the often conflicting freedoms to express homophobic views and to freely express one’s sexual identity. With EU law protecting many of the recently won rights favouring lesbian, gay, bisexual and transgender (LGBT) equality, the purpose of this paper is to underline the potential dangers should this layer of international scrutiny be lost and highlight where more improvements for equality are still needed.

This paper offers a critical reflection on the recent political and judicial rhetoric which has accompanied the issues of LGBT social and legal equality. Recent judgements from domestic and European courts are analysed to identify how any potential re-interpretation of freedom of expression may affect the LGBT community.

While the UK has made welcome strides in improving the legal equality of the LGBT community, it is argued that the potential loss of judicial scrutiny from the European Court of Human Rights and the European Court of Justice may have negative consequences. An examination of recent judicial and political discourse demonstrates that homophobic expression – or at least tacit acceptance of it – still permeates throughout these institutional spheres.

The paper highlights how the subtleties of constitutional changes following Brexit may threaten the current progression of LGBT rights in the UK and proposes that a commitment to freedom of expression must give greater recognition to the right to express sexual identity.

The links between substance use and offending are well evidenced in the literature, and increasingly, substance misuse recovery is being seen as a central component of the process of rehabilitation from offending, with substance use identified as a key criminogenic risk factor. In recent years, research has demonstrated the commonalities between recovery and rehabilitation, and the possible merits of providing interventions to substance-involved offenders that address both problematic sets of behaviours. The purpose of this paper is to provide an overview of the links between substance use and offending, and the burgeoning literature around the parallel processes of recovery and rehabilitation.

This is provided as a rationale for a new treatment approach for substance-involved offenders, Breaking Free Online (BFO), which has recently been provided as part of the “Gateways” throughcare pathfinder in a number of prisons in North-West England. The BFO programme contains specific behaviour change techniques that are generic enough to be applied to change a wide range of behaviours, and so is able to support substance-involved offenders to address their substance use and offending simultaneously.

This dual and multi-target intervention approach has the potential to address multiple, associated areas of need simultaneously, streamlining services and providing more holistic support for individuals, such as substance-involved offenders, who may have multiple and complex needs.

Given the links between substance use and offending, it may be beneficial to provide multi-focussed interventions that address both these behaviours simultaneously, in addition to other areas of multiple and complex needs. Specifically, digital technologies may provide an opportunity to widen access to such multi-focussed interventions, through computer-assisted therapy delivery modalities. Additionally, using digital technologies to deliver such interventions can provide opportunities for joined-up care by making interventions available across both prison and community settings, following offenders on their journey through the criminal justice system.

Recommendations are provided to other intervention developers who may wish to further contribute to widening access to such dual- and multi-focus programmes for substance-involved offenders, based on the experiences developing and evidencing the BFO programme.

The purpose of this paper is to design, build and test a low power high frequency (HF) transmitter that can be received by the Super Dual Auroral Radar Network (SuperDARN) radar installed at SANAE IV, the 4th South African National Antarctic Expedition Station. It is proposed that it may be possible to do propagation studies using the radar and the fixed frequency, ground-based HF transmitter beacon. Interpretation of the measurements can be used to study the ionosphere, especially Travelling Ionospheric Disturbances, which are signatures of atmospheric gravity waves.

In the absence of the actual deployment of the HF transmitter beacon in Antarctica, extensive simulations have been done to evaluate the expected performance of the transmitter in relation to the SuperDARN. A field trial has been executed between Hermanus (34.4241° S, 19.2247° E) and Pretoria (34.0558° S, 18.4589° E) in South Africa. In future, the beacon will be placed at the South Pole with its antenna radiating towards SANAE IV.

The HF transmitter conforms to the power and frequency stability requirements both during propagation tests conducted between Hermanus and Pretoria, as well as when the device was exposed to temperatures that ranged from +40°C to −45°C in a thermal chamber. Propagation in Antarctica is expected to differ from the field tests conducted due to the differences in density and dynamics of the polar ionosphere, compared to the mid-latitude ionosphere.

Space weather research, including forecasting atmospheric gravity waves and determining the expected electron density profile of the ionosphere, is of great scientific interest. The data received from the HF beacon can be used to study and characterize the ionosphere of the region between the South Pole and SANAE IV. Parameters of the ionosphere, such as electron density, geomagnetic storm effects, ionospheric motions and sky wave propagation paths will be better understood from analysing the signal received from this transmitter after it has been reflected and refracted by the ionosphere.

Lost X‐ray films waste time, delay treatment, and may necessitate a patient being exposed to further radiation. Audit of a 132‐bed orthopaedic and trauma department over a 2‐month period showed that 16 patients' X‐ray films were lost. Fifteen (93%) had been stored in anonymous polythene packets. Only 5 (31%) were found within half an hour, and a mean of 67 minutes' working time was occupied locating each one. Recognition of why and where they were lost reduced the number of losses.

Describes the approach developed by the authors in using total quality management philosophies and techniques to address the issues and problems arising from IT service provision. Outlines IT service quality issues and discusses MARQUIS (Managing Requirements and Quality in Services), which can be used to specify users′ requirements and develop service products to fulfil these requirements. Provides a Service Code of Practice (SCOP), and suggests that both it and MARQUIS will be of great benefit to the IT industry and its customers in years to come.

The purpose of this paper is to explore the adoption and implementation of computer-assisted therapy (CAT) using Breaking Free Online (BFO) in a social care and health charity working with people affected by drugs and alcohol dependence, Crime Reduction Initiatives (CRI).

Semi-structured interviews were conducted with service managers, practitioners, peer mentors and service users. Data were thematically analysed and themes conceptualised using Roger's Diffusion of Innovation Theory (Rogers, 1995, 2002, 2004).

A number of perceived barriers to adoption of BFO throughout CRI were identified within the social system, including a lack of IT resources and skills. However, there were numerous perceived benefits of adoption of BFO throughout CRI, including broadening access to effective interventions to support recovery from substance dependence, and promoting digital inclusion. Along with the solutions that were found to the identified barriers to implementation, intentions around longer-term continuation of adoption of the programme were reported, with this process being supported through changes to both the social system and the individuals within it.

The introduction of innovations such as BFO within large organisations like CRI can be perceived as being disruptive, even when individuals within the organisation recognise its benefits. For successful adoption and implementation of such innovations, changes in the social system are required, at organisational and individual levels.

The learning points from this study may be relevant to the substance misuse sector, and more widely to criminal justice, health and social care organisations.

This study is the first of its kind to use a qualitative approach to examine processes of implementation of CAT for substance misuse within a large treatment and recovery organisation.

In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service.

A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74.

Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant.

These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach.

This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.

Too often leaders of multi‐business groups struggle with how to best add value at this level of management. CEOs and business group leaders can improve the odds of success in these roles, and better retain potential successors, by answering three questions: Is there a clear business case for grouping these businesses? Given a clear business case, what are the most important roles the group executive should play? Given these roles, what are the key skills I should look for in each group executive? Drawing from interviews, existing literature, and their own extensive experience, the authors provide frameworks and perspectives that help top executives answer these questions.