Suchergebnisse

This article contends there is an increasingly clear need for a redesign of the UK tax credits system to make tax credit income more stable. Evidence from a recent longitudinal study shows that many tax credit recipient families experience substantial income instability, which is sometimes worsened by the pattern of tax credit receipts. Instability is also introduced by aspects of the system's design, which lead to overpayments. The article highlights arguments for caring about income stability, including the growing literature on how income fluctuations affect child development, as well as evidence from behavioural economics suggesting that effective policy design should consider people's preference for stability. It concludes that a strong contender for such a redesign should be a system of flat payments, reassessed every six months and made responsive to need by allowing families to seek earlier reassessment if required.

Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed 'demonstration sites') during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55–56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.