INTRODUCTION:Co-design is a consumer-driven approach that facilitates consumer participation in creating meaningful solutions to complex problems. Poor uptake of core management strategies for osteoarthritis suggests there is a missing link in translation between research and practice. We partnered with osteoarthritis consumers as 'co-researchers' to identify translational research solutions to improve uptake of core management strategies that are grounded in lived experiences. OBJECTIVE:To transparently describe a theory-driven, generative co-design approach using an integrated conceptual framework to collaborate with consumers at the equal partnership level. DESIGN:We used co-design workshops with a non-hierarchical participatory framework. Three workshops with six co-researchers [2 female, mean age 68.7 (9.8) years, 3-30 years symptom duration] were conducted using activities to encourage creative thinking, promote deep reflection on personal/societal beliefs and minimise sensitivities around sharing personal beliefs (e.g., establishing a safe space, prompting questions, perspective-taking, counter-stereotypical exemplars). RESULTS:All six co-researchers actively participated in the workshops. Achievement of an equal collaborative partnership was evidenced by co-researchers challenging a project proposed by the research team and making alternative recommendations that have been implemented in prospective decision-making - representing a complete change in research focus driven by consumer input. A key suggested solution was to develop a scalable knowledge translation intervention that targets misconceptions about osteoarthritis and its management at the societal-level. CONCLUSIONS:Through an innovative co-design approach in partnership with co-researchers, we identified meaningful areas on which to focus translational research for osteoarthritis. Discordance between existing research priorities and novel solutions proposed by co-researchers highlights the value of co-design.

This chapter introduces the role of plans and policy in the making and management of place and space. It refers to some of the key components of a typical plan, and outlines some key plan-making principles, such as the need for an effective evidence base and proactive community and stakeholder involvement. The chapter introduces the concept of the UK’s plan-led system and the role of the statutory development plan. It introduces key policy goals and outlines some of the plan-making activities that planners need to engage with. It identifies the need for plans to be sustainable, and outlines how planners seek to ensure different social economic and environmental goals are being met.

BackgroundSafety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted.ObjectivesThe aim of the review was to identify measures that could be used as indicators of safety for quality monitoring and improvement in older adult residential or nursing care homes.Sources of evidenceSystematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019.Eligibility criteriaInclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home. A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria.Charting methodsKey information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.Results and conclusionsSystematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home.A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the SMMF. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.

Background: Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives: The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design: This was a mixed-methods study. Setting: The setting was care homes for older adults in England. Participants: Care home residents participated. Results: Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%. Limitations: No care homes rated as inadequate were recruited to the study. Conclusions: The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents. Future work: Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

Green infrastructure is understood to be a critical feature of sustainable cities, providing numerous benefits to people and wildlife. However, there are challenges associated with its planning, design and delivery related to skills and knowledge in the built environment sector and the importance placed on green infrastructure in the development process. The sector often turns to assessment systems to ensure that new developments are sustainable, with the standards and criteria they include being used to inform those responsible for delivering commercial and residential developments. This chapter examines thirteen systems commonly used internationally against the key characteristics of green infrastructure including its form as a multifunctional network, relationship with the strategic objectives for the area and functions for improving health and well-being, climate change resilience and nature conservation. The findings suggest that the majority of systems do not provide a robust assessment of green infrastructure against these characteristics. Although they do recognise many of the functions that green infrastructure can provide, they miss opportunities for the additive benefits that can be provided through a multifunctional network. Many of the systems will accredit developments to some degree with very little or no consideration of green infrastructure, giving the impression that it is not an essential component of new development. Built environment assessment systems play an important role in setting the standard for the sector and, as such, could contribute to improving the quality of green infrastructure in the future.

This chapter reflects on reasons for neoliberalism’s surprising resiliency in the post-financial crisis period, such as its deep institutionalisation at both the national and international levels and the absence of major hegemonic rivals. It also considers whether Brexit and Corbynism might, at long last, spell the end of the neoliberal experiment in British politics.

Context: Poorer mortality rates and quality of care in hospitals outside of office hours is well documented. The literature on adult social (long-term) care, and in particular, care homes, is much less developed. There are, however, a few studies that suggest that outside of Monday to Friday between 9.00am and 16.30pm, quality of care in care homes might be lower.Objective(s): The objective of this study was to compare the social care-related quality of life (SCRQoL) of residents in older adult care homes during office hours (0900 to 16.30) with outside of office hours (evenings and weekends).Method(s): We conducted a nested, cross-sectional study, collecting SCRQoL data using the Adult Social Care Outcomes Toolkit at two time points, office hours (Monday-Friday between 9.00 and 16.30) and outside of office hours. We did not examine nigh times in the homes. Data were collected for 99 older adult care home residents in 13 care homes (5 residential and 8 nursing) and analysed using a combination of non-parametric and parametric techniques.Findings: SCRQoL ratings were lower during the weekends and early evenings than during office hours. The differences were most pronounced in the higher order domains of social participation, occupation and control over daily life.Limitations: The study struggled to explain this variation. This work was both exploratory and small in size. We also did not collect data on levels of staffing.Implications: Further work is required to both confirm our findings and explore the reasons for the difference. Nonetheless, this study challenges the traditional model of care, in which social activities and meaningful pastimes are mostly organised during ‘office hours’. We observed evenings that were very short, as residents tended to return to their room shortly after dinner, and quiet weekends, and this was reflected in residents’ quality of life. This is contrary to the rhetoric of care homes being people’s own homes, where they would be able to choose to remain active and engaged into the evening and on the weekends, as they may have done throughout their lives.

Background: The ASCOT-ER is an adapted easy-read version of the ASCOT-SCT4, a self-report measure of social care-related quality of life (SCRQoL) for social care evaluation. In this study, we investigated the instrument's feasibility, construct validity and factor structure. Method: Data were collected from 264 service users in England. Feasibility was evaluated by missing data and help to complete the questionnaire. Scale dimensionality was assessed using exploratory factor analysis. Construct validity was evaluated by hypothesis testing. Results: Convergent validity was supported by moderate to strong correlations between ASCOT-ER and personal wellbeing and overall quality of life, as well as with individual characteristics. Exploratory factor analysis indicated that the ASCOT-ER is a unidimensional scale. Low missingness indicates that the instrument is feasible; however, most respondents needed some level of support to complete the questionnaire. Conclusion: The study provides preliminary evidence of the ASCOT-ER's feasibility, unidimensionality and construct validity.

This fully updated short guide discusses the planning system, processes, legal constructs and approaches, taking into account the recent regulatory changes within the UK nations. It explores the interactions of government and society with the planning system, encouraging the reader to adopt a reflective and inquisitive outlook.

The challenges of engaging care homes in health and social care research is well reported (Bower et al., 2009; Patel et al., 2003). Managers and owners have competing pressures on their time (e.g. providing high quality and compassionate care, recruiting and retaining staff, complying with the requirements of the regulator, commissioners and their own auditing systems, liaising with family members and supporting informal carers). It is understandable that under these conditions, research is not always a priority. Mechanisms are being set up in the UK to help care homes become ‘research ready’ and guidelines for best practice are becoming available to facilitate engagement as much as possible (ENRICH website/reports). However, recruitment remains a significant challenge for many studies (Bower et al., 2009). Since 2015, the Measuring Outcomes in Care Homes Study (MOOCH) has successfully recruited 34 care homes (including nursing homes) and 293 residents, including those lacking the capacity to consent. The project faced numerous challenges early on, including local authority partners withdrawing from the research due to restructuring within their organisation. This paper shares our learning, reflecting on which strategies worked and which did not (and why), including; research ready homes, partnership working, payment to care homes, presenting at provider events, having support from CQC and local commissioning teams and providing care homes with feedback reports. We will also present the results from our care home manager debrief interviews, where managers were asked their motivations for taking part in the study and their experiences of being research participants.

ABSTRACTThe benefits of meaningful activity in later life are well documented. Studies show that being occupied contributes to both physical and mental health as well as quality of life. Research also suggests that activity may be beneficial to people residing in care homes, including people living with dementia. This paper presents findings from a study which used the Adult Social Care Outcomes Toolkit (ASCOT) to measure quality of life in six care homes located in the south-east of England. The study found, like previous ones, that care home residents’ days were characterised by a lack of activity. Drawing on observations, interviews and focus groups with residents and staff from these homes, this paper attempts to understand why care home residents do not engage in meaningful activities. We reject the idea that these low levels of activity are a natural part of the ageing process or that they can be explained by notions of resident choice. Instead, the findings point to both insufficient funding and working practices within care homes as more substantive explanations. These explanations inform a discussion of how the low levels of engagement in meaningful activity could be addressed and residents’ quality of life improved.

Green infrastructure (GI) is globally recognised as an essential component of liveable and sustainable places.It is valued for its multifunctionality and the connectedness of the individual features to each other, the surrounding countryside and urban populations.It brings together many land uses (e.g.parks, gardens, cemeteries, allotments, nature reserves, surface water), urban design (e.g.street trees, landscaping) and functional features (e.g.sustainable urban drainage systems, green roofs) operating at differing spatial scales.It is widely acknowledged that GI is the primary mechanism for delivering ecosystem services in towns and cities, and there is a substantial body of research demonstrating the multiple benefits of GI to urban populations.Despite this evidence base, there is still considerable uncertainty about the best way to design, deliver and maintain GI.This paper presents an emerging benchmark that has been developed through a combination of literature review and engagement with key stakeholders.It provides a suite of standards that are flexible enough to be used across different spatial scales depending on the specific needs of the location, covering the form and function of GI including nature conservation, water management, health and well-being, environmental and design quality.It allows an assessment of GI policy, and the planning, design, delivery and long-term management of GI in new and existing places, ensuring that current good practice is adopted at all stages.The development of the benchmark to date is summarised along with the outcome of preliminary testing using the outline planning applications for two contrasting mixed-use developments.This found that the benchmark performed well, with standards set at a level to ensure that high-quality GI is rewarded but without requiring a level of GI provision and quality that would only be expected on truly exemplary developments.Plans for the future development and testing of the benchmark are provided.

Green infrastructure is an essential component of health and sustainable places. The quality of green infrastructure often represents a missed opportunity to achieve this. This paper presents a review examining how built environment assessment systems evaluate the quality of green infrastructure. This was used to develop proposals for a new benchmark, which were examined by experts in terms of the demand, scope and operation. The findings suggest that current systems are not providing a robust assessment of green infrastructure and that a benchmark for green infrastructure would overcome some of the challenges associated with its planning, design and delivery.

The challenges of engaging care homes in health and social care research is well reported (Bower et al., 2009; Patel et al., 2003). Managers and owners have competing pressures on their time (e.g. providing high quality and compassionate care, recruiting and retaining staff, complying with the requirements of the regulator, commissioners and their own auditing systems, liaising with family members and supporting informal carers). It is understandable that under these conditions, research is not always a priority. Mechanisms are being set up in the UK to help care homes become ‘research ready’ and guidelines for best practice are becoming available to facilitate engagement as much as possible (ENRICH website/reports). However, recruitment remains a significant challenge for many studies (Bower et al., 2009). Since 2015, the Measuring Outcomes in Care Homes Study (MOOCH) has successfully recruited 34 care homes (including nursing homes) and 293 residents, including those lacking the capacity to consent. The project faced numerous challenges early on, including local authority partners withdrawing from the research due to restructuring within their organisation. This paper shares our learning, reflecting on which strategies worked and which did not (and why), including; research ready homes, partnership working, payment to care homes, presenting at provider events, having support from CQC and local commissioning teams and providing care homes with feedback reports. We will also present the results from our care home manager debrief interviews, where managers were asked their motivations for taking part in the study and their experiences of being research participants.

The success of green infrastructure (GI) depends on the sharing of good practice and research between disciplines and sectors. This paper presents findings from a study to examine how GI research is shared with non-academic audiences. GI has been an active research area in recent years, with a wealth of evidence coming from the academic community. This has been mirrored by a body of grey literature aimed at different disciplines and sectors. But it is important to understand which evidence is being used in this grey literature and what the gaps are either in research or in its translation. In this study, 25 pieces of grey literature were reviewed to identify what research is represented; presented as the benefits or ecosystem services provided by different types of GI. This review was presented to around 70 academics, policy makers and practitioners working in GI through two workshops. Attendees were asked questions in order to further understanding of how research is translated and used, and the mechanisms by which it can be more effectively shared. The paper provides insights into how those working in GI can work collaboratively to ensure research findings are relevant and usable.

This paper outlines the aims, development and proposed operation of Building with Nature, a new benchmark for appraising the quality of green infrastructure