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The purpose of this paper is to evaluate the practical implementation of the Integrated Risk Management Planning process through its application within the Fire Cover Review project in Nottinghamshire, in order to identify good practice and recommendations for improving the process and its implementation.

The paper takes the form of an in‐depth case study over an 18 month period using participant observation, documents analysis, interviews with key stakeholders and the response to a public consultation exercise.

Recent public expenditure restrictions manifestly influenced and contextualised the attitude and response from the public and all key stakeholders to the project. It was the first consultation undertaken by the Service which was also significantly affected by the internet and social media. The open and transparent approach adopted reduced misinformation and promoted ownership and accountability of the project, from both the Service and the Authority.

The paper is the first comprehensive review of the reconfiguration of services undertaken during the current financial crisis and in the context of the new coalition government's public sector policy.

The paper aims to explore the relationship between commissioners of service and the third sector arising from research undertaken during a LinkAge Plus project by comparison to the eight principles of commissioning. It seeks to explore the issues concerning the development of services and the implications in an era of austerity for rapid changes to the implementation of policy nationally in the UK and internationally.

The main methods employed are interview, document analysis and observation. This research re‐evaluates research undertaken for a LinkAge Plus pilot evaluation.

The framework provided by the eight principles of good commissioning appeared to rely on the premise that the contracts entered into are long‐term in nature, however, where short‐term contracts are entered into the principles appear somewhat unachievable.

The paper examines the findings arising from one LinkAge Plus pilot site only, however, the authors contend that the findings offer genuine insights into the relationship between commissioners of services and the third sector, owing to the number of projects undertaken for the scheme.

The findings offer organisations and policy makers an insight into the issues faced by the third sector when dealing with large commissioners particularly with regards to the rapid change of service provision and short‐term contracts. This has considerable relevance in the changing economic climate and the associated austerity measures being imposed. The paper also fulfils the need for greater empirical work required in the important area of third sector delivery of services.

LinkAge Plus offered a unique opportunity to examine how a commissioner can use third sector organisations to develop services quickly and the associated issues that arise.

Life expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.

A single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.

Implementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.

This study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.

In 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.

Public engagement in health technology assessment (HTA) is increasingly considered crucial for good decision making. Determining the “right” type of engagement activity is key in achieving the appropriate consideration of public values. Little is known about the factors that determine how HTA organizations (HTAOs) decide on their method of public engagement, and there are a number of possible factors that might shape these decisions. The purpose of this paper is to understand the potential drivers of public engagement from an organizational perspective.

The published HTA literature is reviewed alongside existing frameworks of public engagement in order to elucidate key factors influencing the choice of public engagement process undertaken by HTAOs. A conceptual framework is then developed to illustrate the factors identified from the literature that appear to influence public engagement choice.

Determining the type of public engagement undertaken in HTA is based on multiple factors, some of which are not always explicitly acknowledged. These factors included the: perceived complexity of the policy-making issue, perceived impact of the decision, transparency and opportunities for public involvement in governance, as well as time and resource constraints. The influences of these factors vary depending on the context, indicating that a one size fits all approach to public engagement may not be effective.

Awareness of the various factors that might influence the type of public engagement undertaken would enable decision makers to reflect on their choices and be more accountable and transparent about their choice of engagement process in eliciting public values and preferences in a HTAO.