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This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research.

This paper provides a conceptual analysis. It proposes that public and patient trust in health care in the UK appears to be shaped by a variety of factors. From a macro perspective, any changes in levels of public trust in health care institutions appear to derive partly from top‐down policy initiatives that have altered the way in which health services are organised and partly from broader social and cultural processes. A variety of policy initiatives, including the introduction of clinical governance and the resulting use of performance management to scrutinise and change clinical activity, increasing patient choice and involvement in decision‐making regarding their care, are examined for how they have changed the context for trust relations within the NHS.

It is argued that these policy initiatives have produced a new context for trust relations within the NHS, shifting the inter‐dependence and distribution of power between patients, clinicians, and mangers and changing their vulnerability to each other and to health care institutions. The paper presents a theoretical framework based on current policy discourses which illustrates how new forms of trust relations may be emerging in this new context of health care delivery, reflecting a change in motivations for trust from affect based to cognition based trust as patients, clinicians and managers become more active partners in trust relations. The framework suggests that trust relations in all three types of relationship in the “new” modernised NHS might, in general, be particularly characterised by an emphasis on communication, providing information and the use of “evidence” to support decisions in a reciprocal, negotiated alliance.

The paper examines the drivers for change in trust in health care relations in the UK and develops a theoretical framework for the emergence of new trust relations that can be subsequently explored through empirical research.

Transmission routes that may contribute to the overall picture of campylobacteriosis and salmonellosis were explored by analysing the outside surfaces of 300 retail raw chicken packs for prevalence and enumeration of Campylobacter using a MPN/PCR assay and Salmonella using a MPN/visual immunoassay procedure. The surfaces of 72 packs (24.0 per cent) were externally contaminated with C. jejuni; 32 with counts of <6 MPN/pack and the remaining 40 with counts ranging from 6 to >2,200 MPN/pack. One whole chicken sample (0.3 per cent) was contaminated with S. Tennessee at <6 MPN/pack. The surfaces of offal packs were most contaminated with Campylobacter, with 18 per cent having a count of ≥100 MPN/pack in comparison with chicken portion packs (4/200, 2 per cent) and whole bird packs (1/50, 2 per cent). These observations suggest that packs could be a source of cross‐contamination, however, the contribution of this outer surface contamination pathway to foodborne illness can only be properly determined by development of a validated risk assessment model.

THE proposition that British library schools should examine their own students is not a new one. As long ago as 1954, Roy Stokes put the question bluntly to the profession. In those days his was a voice crying in the wilderness. The profession at large was not ready for such a development, and continued to adhere to its long held view that the Library Association should examine the products of the schools, while the schools confined themselves to teaching.

The purpose of this paper is to highlight theoretical and clinical similarities between therapeutic communities (TCs) and group analysis (GA).

Literature review shows comparison of TC and group-analytic concepts with illustrative case material.

Findings reveal many similarities between TCs and GA, but also significant divergences, particularly in practice.

This paper provides theoretical basis for TC practice, and highlights the need for greater theorising of TC practice.

This paper highlights the importance of group-based treatment approaches in mental health.

This is the first paper to review the relevant literature and compare theory and practice in TCs and GA, highlighting their common roots in the Northfields Experiments in the Second World War.

This paper presents some key theoretical issues about trust, and seeks to demonstrate their relevance to understanding of, and research on, health systems. Although drawing particularly on empirical evidence from low‐ and middle‐income countries (LMICs), the paper aims to stimulate thinking across country settings.

Drawing both on conceptual literature and relevant empirical research from LMICs, the paper presents an argument about the role of trust within key health system relationships and identifies future research needs.

Theoretical perspectives on four questions are first discussed: what is trust and can it be constructed? Why does it matter to health systems? On what is it based? What are the dangers of trust? The relevance of these theoretical perspectives is then considered in relation to: understanding the nature of health systems; issues of equity and justice in health care; and policy and managerial priorities. The identified research needs are investigation of: the role of trusting workplace relationships as a source of non‐financial incentives; the influence of trust over the operation of different forms of citizen‐health system engagement; approaches to training trustworthy public managers; and the institutional developments required to sustain trustworthy behaviour within health systems.

The policy and management actions needed to strengthen health systems within LMICs, and elsewhere, include: recruitment of health workers that have the attitudes and capacity for moral understanding and motivation; training curriculae that develop such motivation; and developing the institutions (e.g. communication and decision‐making practices, payment mechanisms) that can sustain trusting relationships across a health system. It is also important to recognise that distrust in some relationships may act to guard against the abuse of power.

Although the notion of trust has become of increasing importance in health policy debates in high‐income countries, it has received less attention in the context of LMICs. The papers adds to the very limited literature on trust in LMIC health systems and also opens new lines of thinking for those working in high income countries – particularly around the role of health systems in generating wider social value.

This article summarises the historical development of positive behavioural support. The main features of this approach are described, and the evidence for its effectiveness outlined. Despite clear empirical support for its use, relatively few people with learning disabilities and challenging behaviour appear to have access to this form of therapeutic intervention. Reasons for this are discussed, along with recommendations for future development.