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This study aims to explore how the COVID-19 pandemic has impacted parents of autistic children and their families in Ireland.

A qualitative thematic analysis methodology was applied using semi-structured interviews. A total of 12 parents (ten mothers, one father and one grandfather speaking on behalf of a mother) of autistic children were asked how the COVID-19 pandemic impacted them and their autistic child with a particular focus on how it has impacted their access to respite care. Interviews were completed remotely from July 2021 to October 2021.

Data analysis identified four themes that reflect an adverse pandemic impact. These were: world gone; alone and isolated; constantly fighting for help; and negative and positive impact of COVID-19 on child and family. Two parents reported positive outcomes of the pandemic such as social distance requirements. Five parents (42%) reported an increase in the amount of respite received. Three parents (25%) reported a decrease and four (33%) parents reported no change in their access to respite.

COVID-19 has turned a spotlight on mental health for politicians, policymakers and the public and provides an opportunity to make mental health a higher public health priority for autistic children and their families.

This study highlights the need for access to respite for autistic children and for respite services to be responsive to the ongoing needs, in particular, the mental health needs of autistic children and their family, particularly in a crisis situation.

Improvements in neonatal and paediatric care mean that many children with complex care needs (CCNs) now survive into adulthood. This cohort of children places great challenges on health and social care delivery in the community: they require dynamic and responsive health and social care over a long period of time; they require organisational and delivery coordination functions; and health issues such as minor illnesses, normally presented to primary care, must be addressed in the context of the complex health issues. Their clinical presentation may challenge local care management. The project explored the interface between primary care and specialised health services and found that it is not easily navigated by children with CCNs and their families across the European Union and the European Economic Area countries. We described the referral-discharge interface, the management of a child with CCNs at the acute–community interface, social care, nursing preparedness for practice and the experiences of the child and family in all Models of Child Health Appraised countries. We investigated data integration and the presence of validated standards of care, including governance and co-creation of care. A separate enquiry was conducted into how care is accessed for children with enduring mental health disorders. This included the level of parental involvement and the presence of multidisciplinary teams in their care. For all children with CCNs, we found wide variation in access to, and governance of, care. Effective communication between the child, family and health services remains challenging, often with fragmentation of care delivery across the health and social care sector and limited service availability.

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Recent studies have shown that the contribution of small firms to employment and GDP is increasing. A large amount of work has also established the significance of social and economic variables for entrepreneurial decisions. Very little is known, however, about how government policies and programs influence entrepreneurial activity, and whether these effects are consistent across countries. Using original data from a representative sample of 10,000 individuals and from more than 300 open-ended interviews in 10 countries, this article provides some suggestive evidence that government intervention aimed at enhancing the underlying environment of entrepreneurial decisions may be more effective than intervention designed to provide safety nets.

Previous research has identified associations between quality management and employee health. This study's purpose was to (1) examine those associations in a public healthcare organisation and (2) explore and describe the association between digitalisation and employee health.

An online questionnaire including indices to measure quality management values, employee health and digitalisation was answered by 118 managers in Swedish public healthcare. Correlation analysis was used to analyse the data. Based on the survey results, 12 qualitative, in-depth interviews were conducted with healthcare managers.

The findings show that employee health is associated with quality management and digitalisation. Categories were defined to describe the managers' views of the relationship between digitalisation and health.

Causality was not explicitly tested and cannot be assumed. However, the results strengthen the body of research showing that quality management is related to employee health, and associations between health and digitalisation were identified.

The findings and model should be helpful for healthcare managers in a digitalising environment who aim to preserve or enhance employee health whilst ensuring high service quality.

The results were used to create an integrated conceptual model depicting the association between quality, digitalisation and health. This association has not previously been studied.