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People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.

The paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.

Supporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.

The data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.

Integration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.

Addressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.

This paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

This integrated care study seeks to highlight how voluntary sector “wellbeing co-ordinators” co-located in a horizontally and vertically integrated, multidisciplinary community hub within one locality of an Integrated Care Organisation contribute to complex, person-centred, co-ordinated care.

This is a naturalistic, mixed method and mixed data study. It is complementing a before-and-after study with a sub-group analysis of people receiving input from the wider hub (including Wellbeing Co-ordination and Enhanced Intermediate Care), qualitative case studies, interviews, and observations co-produced with embedded researchers-in-residence.

The cross-case analysis uses trajectories and outcome patterns across six client groups to illustrate the bio-psycho-social complexity of each group across the life course, corresponding with the range of inputs offered by the hub.

To consider the effectiveness and mechanisms of complex system-wide interventions operating at horizontal and vertical interfaces and researching this applying co-produced, embedded, naturalistic and mixed methods approaches.

How a bio-psycho-social approach by a wellbeing co-ordinator can contribute to improved person reported outcomes from a range of preventive, rehabilitation, palliative care and bereavement services in the community.

To combine knowledge about individuals held in the community to align the respective inputs, and expectations about outcomes while considering networked pathways based on functional status, above diagnostic pathways, and along a life-continuum.

The hub as a whole seems to (1) Enhance engagement through relationship, trust and activation, (2) Exchanging knowledge to co-create a shared bio-psycho-social understanding of each individual’s situation and goals, (3) Personalising care planning by utilising the range of available resources to ensure needs are met, and (4) Enhancing co-ordination and ongoing care through multi-disciplinary working between practitioners, across teams and sectors.

Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the managerial workaround. It further develops and revises this conceptualisation by comparing the practical management, at both provider and purchaser levels, of hospital DRG payment systems in England, Germany and Italy.

We make a qualitative test of our initial assumptions about the antecedents, character and consequences of managerial workarounds by comparing them with a systematic comparison of case studies of the DRG hospital payment systems in England, Germany and Italy. The data collection through key informant interviews (N = 154), analysis of policy documents (N = 111) and an action learning set, began in 2010–12, with additional data collection from key informants and administrative documents continuing in 2018–19 to supplement and update our findings.

Managers in all three countries developed very similar workarounds to contain healthcare costs to payers. To weaken DRG incentives to increase hospital activity, managers agreed to lower DRG payments for episodes of care above an agreed case-load ‘ceiling' and reduced payments by less than the full DRG amounts when activity fell below an agreed ‘floor' volume.

Empirically this study is limited to three OECD health systems, but since our findings come from both Bismarckian (social-insurance) and Beveridge (tax-financed) systems, they are likely to be more widely applicable. In many countries, DRGs coexist with non-DRG or pre-DRG systems, so these findings may also reflect a specific, perhaps transient, stage in DRG-system development. Probably there are also other kinds of managerial workaround, yet to be researched. Doing so would doubtlessly refine and nuance the conceptualisation of the ‘managerial workaround’ still further.

In the case of DRGs, the managerial workarounds were instances of ‘constructive deviance' which enabled payers to reduce the adverse financial consequences, for them, arising from DRG incentives. The understanding of apparent failures or part-failures to transform a health system can be made more nuanced, balanced and diagnostic by using the concept of the ‘managerial workaround'.

Managerial workarounds also appear outside the health sector, so the present analysis of managerial workarounds may also have application to understanding attempts to transform such sectors as education, social care and environmental protection.

So far as we are aware, no other study presents and tests the concept of a ‘managerial workaround'. Pervasive, non-trivial managerial workarounds may be symptoms of mismatched policy objectives, or that existing health system structures cannot realise current policy objectives; but the workarounds themselves may also contain solutions to these problems.

This paper gives a comparative analysis of the foundation of sinology in two Canadian universities. Despite not having diplomatic exchanges, Canada's new relationship with the People's Republic of China (PRC) ignited a China interest in the Canadian academe. Through York University and the University of Guelph (U of G)'s experiences, readers will learn the rewards and challenges that sinology brings to Canadian higher education.

This paper offers an overview of the historical foundation of sinology in the Canadian academe. Who pushes through this process? What geopolitical developments triggered young and educated Canadians to learn about China? This paper assesses York and Guelph's process in introducing sinology by relying on university archival resources and personal interviews. Why was York University successful in its mission, which, in turn, made into a comprehensive East Asian Studies degree option in 1971? What obstacles did the U of G face that prohibited it from implementing China Studies successfully?

After 1949, Canada took a friendlier relationship with the PRC than its neighbor in the south. As China–Canada relations unfolded, Canadian witnessed a dramatic state investment in higher education. The 1960s was a decade of unprecedented university expansion. In the process, sinology enjoyed its significant growth, and both York University and the U of G made their full use of this right timing. However, China Studies at the U of G did not take off. Besides its geolocation disadvantage, Guelph's top-down managerial style in the 1960s, which resulted in collegial disillusionment, was also a significant barrier to this program's success.

Before the Internet age, universities were the first venues for most Canadians to acquire their initial academic knowledge of China. After the Second World War, sinology became popular among students as China became one of the world's “Big Fives”. More Canadians became romanticized with Maoism while opposing America's containment policy. York and Guelph exemplified this trend in Canadian history. Contrary to popular belief, historian Jerome Chen did not establish York's China Studies. Likewise, an ex-US diplomat John Melby did not bring China into Guelph, sinology arrived due to individual scholastic initiatives. Visionaries saw envisioned China's importance in the future world community.

Border crossing between systemic and racial identity theories can contribute to systemic research on Black therapists work with White families.

Questionnaires were used to gather data from 29 Black, Asian and Mixed Heritage therapists in order to test the significance of variables associated with transgenerational advice, socialisation experience, professional training and therapists’ perception of successful outcomes (n=29). The study concluded that White clients were associated with the contact and disintegration statuses at the beginning of therapy, and that Black therapists were associated with being at least two racial identity statuses in advance of their White clients. In addition, results showed that there was a significant association with eye contact and White clients across all racial identity statuses in therapy, and that the therapist’s age was significantly associated with therapeutic experiences, length of therapeutic practice and the belief in working with unintentional racism in therapy. The outcome of this study will have policy implications in terms of clinical practice and supervision.

Much has been written and spoken about the theory of designing and implementing anti money‐laundering procedures in financial institutions in the UK. Such analysis, it has to be said, while valuable, is generally made by those who inhabit the groves of academia and by learned friends from the legal profession from the safety of solicitors' offices. This article puts another viewpoint: that of the humble money laundering reporting officer (MLRO) in a financial institution, faced with the task of implementing the requirements of the legislation, the task of persuading his management that there needs to be a proper awareness campaign, the task of creating interest in that campaign and getting everybody along to the video and finally the task of establishing a culture of reporting of suspicions sensibly.

As yet there are no indications that the President of the Local Government Board intends to give the force of law to the recommendations submitted to him by the Departmental Committee appointed by the Board to inquire into the use of preservatives and colouring matters in food. It is earnestly to be hoped that at least some of the recommendations of the Committee will become law. It is in the highest degree objectionable that when a Committee of the kind has been appointed, and has carried out a long and difficult investigation, the recommendations which it finally makes should be treated with indifference and should not be acted upon. If effect should not be given to the views arrived at after the careful consideration given to the whole subject by the Committee, a very heavy responsibility would rest upon the Authorities, and it cannot but be admitted that the Committee ought never to have been appointed if it was not originally intended that its recommendations should be made legally effective. Every sensible person who takes the trouble to study the evidence and the report must come to the conclusion that the enforcement of the recommendations is urgently required upon health considerations alone, and must see that a long‐suffering public is entitled to receive rather more protection than the existing legal enactments can afford. To refrain from legalising the principal recommendations in the face of such evidence and of such a report would almost amount to criminal negligence and folly. We are well aware that the subject is not one that is easily “understanded of the people,” and that the complicated ignorance of various noisy persons who imagine that they have a right to hold opinions upon it is one of the stumbling blocks in the way of reform; but we believe that this ignorance is confined, in the main, to irresponsible individuals, and that the Government Authorities concerned are not going to provide the public with a painful exhibition of incapacity and inaction in connection with the matter. There is some satisfaction in knowing that although the recommendations have not yet passed into law, they can be used with powerful effect in any prosecutions for the offence of food‐drugging which the more enlightened Local Authorities may be willing to institute, since it can no longer be alleged that the question of preservatives is still “under the consideration” of the Departmental Committee, and since it cannot be contended that the recommendations made leave any room for doubt as to the Committee's conclusions.