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The 1995 guidance HSG(95)8 "NHS Responsibilities for Meeting Continuing Health Care Needs" required health authorities to develop local policies and eligibility criteria for a range of continuing care services. The role of criteria in defining health need, and the potential effect on open‐ended rights to NHS care, need to be considered in light of the prior erosion of rights associated with changes in continuing care provision. This paper examines whether the development of eligibility criteria has led to a loss of entitlements to NHS care. Analysis of empirical evidence from a study of the policies and criteria of six health authorities found that criteria for fully funded care were generally well defined and restricted access to those with very intense and specialist needs, thereby constituting a loss of rights. In contrast, the criteria for community‐based services left eligibility dependent on professional discretion but often failed to clarify the relationship between individual need and levels of service provision. The research found that resource limits are likely to remain a factor in the allocation of services and this will affect the status of the criteria as potential entitlements.

Effective knowledge translation processes are critical for the development of evidence-based public health policy and practice. This paper reports on the design and implementation of an innovative approach to knowledge translation within a mixed methods study on lay involvement in public health programme delivery. The study design drew on scientific and experiential knowledge, and included iterative feedback loops to ensure that lay and professional perspectives shaped the research process and dissemination outputs. The paper concludes by discussing the application of this approach as a means to close the knowledge-practice gap in public health.

People-centred public health provides a comprehensive and accessible overview of policy, practice and research in how members of the public can be involved in delivering health improvement as volunteers or lay health workers, drawing on a major study of lay engagement in public health, and using case studies and real life examples

OBJECTIVES: The aim of the study was to identify key elements of whole system approaches to building healthy communities and putting communities at the heart of public health with a focus on public health practice to reduce health inequalities. DESIGN: A mixed-method qualitative study was undertaken. The primary method was semi-structured interviews with 17 public health leaders from 12 local areas. This was supplemented by a rapid review of literature, a survey of 342 members of the public via Public Health England's (PHE) People's Panel and a round-table discussion with 23 stakeholders. SETTING: Local government in England. RESULTS: Eleven elements of community-centred public health practice that constitute taking a whole system approach were identified. These were grouped into the headings of involving, strengthening, scaling and sustaining. The elements were underpinned by a set of values and principles. CONCLUSION: Local public health leaders are in a strong position to develop a whole system approach to reducing health inequalities that puts communities at its heart. The elements, values and principles summarise what a supportive infrastructure looks like and this could be further tested with other localities and communities as a framework for scaling community-centred public health.

The aim of this paper is to critically examine the rationale for citizen engagement in the delivery of public health programmes through exploring perspectives on volunteer roles in two case studies: a neighbourhood health project based in a disadvantaged housing estate and a sexual health outreach project working with men who have sex with men. Interviews were conducted with stakeholders, including managers, practitioners, volunteers and service users. Volunteers were found to perform a bridging function, connecting disadvantaged communities to welfare provision, and they were engaged in social networks beyond their immediate role. The paper concludes by arguing that citizen engagement in public health is not a superficial response to welfare deficits, but should be framed as an appropriate strategy to address health inequalities at community level, within a citizenship framework.

AbstractDespite volunteering being a feature of community life in the UK, differences as to who volunteers are evident. Reporting on a rapid review of the evidence on volunteering and inequalities, the aim of this paper is to provide an overview of the breadth and interconnectedness of barriers to volunteering for potentially disadvantaged groups. Sixty-seven articles were identified, to produce a map of factors affecting volunteer participation. Findings suggest that whilst different demographic groups experience specific barriers to volunteering, there are areas of commonality. Analysis shifts the onus of volunteering away from the level of individual choice (a dominant emphasis in policy and practical discussions around promoting volunteering) and towards the influence of structural factors related to broader exclusionary processes. Those who potentially have the most to gain from volunteering are the least likely to participate. Whilst the benefits of volunteering are increasingly documented by research and championed by policy, there are questions about the success of this approach given that the underlying social inequalities present substantive barriers to volunteering and must be addressed to promote greater access.

The paper aims to examine National Health Insurance Scheme (NHIS) policy from the perspective of local communities. Qualitative data from nine key informant interviews and seventy-two community respondents in nine focus group discussions (FGD) were conducted. The FGDs took place in seven different communities in seven regions of Ghana. The data were analysed using thematic network approach. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results indicated lack of voice and understanding as features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed: first, lack of stakeholder engagement and consultation or participation in the NHIS decision making process. Second it was established that while the policy indicated a will to include all the core poor for an equitable NHIS, there is lack of willingness to implement this aim fully. Finally, despite being a pro- poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the centre undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. The paper proposes that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding and voices should be recognised to shape the future NHIS policy and practice.

Even though a number of studies have examined the implementation of National Health Insurance Scheme (NHIS) in Ghana, its equity and access significance in relation to community perspective has not been assessed nationally. We looked at the NHIS from the perspective of local communities in focus groups discussions (FGDs) and key informant interviews. Qualitative data from nine key informant interviews and seventy-two community respondents in nine focus group discussions were collected. The focus groups took place in seven different communities purposely selected. The data were analysed using thematic network approach. The key informants and focus groups were analysed together. The findings noted a disconnection between NHIS policy and community life. More so, the findings showed an explicit link between equity and access with its impacts on health outcomes. The qualitative results noted lack of voice and understanding as features limiting people from accessing the NHIS facilities. Understanding of equity as a key theme revealed: first, lack of stakeholder engagement and consultation or participation in the NHIS decision making process. Second, the NHIS displayed an overreliance on healthcare and an emphasis on a biomedical approach. Finally, despite being a pro- poor intervention by name, practical management of the NHIS is transmitted down vertical silos from the national level, with the lack of joined-up government at the centre undermining local partnerships. Thus, not only are national expectations being dashed locally, local expectations are dashed nationally. We proposed that community viewpoints should be given higher priority given that NHIS has since its inception been associated with medical treatments and biomedical paradigm. Promoting community participation, understanding and voices should be recognised to shape the future NHIS policy and practice.

This paper responds to challenges around how to generate robust evidence in keeping with the principles of an asset-based approach based on mobilization of community strengths. The design of a collaborative evaluation of a multi-site Asset Based Community Development program is described and emergent learning discussed. A qualitative mixed method design was used to capture changes at community and program level drawing on diverse sources of evidence. Shared principles on the conduct of the evaluation were developed with program leads and community practitioners and opportunities for shared learning were built in. The paper distils learning on evaluation into six design features including the asset-based model as a framework, understandings of evidence and outcomes, ethical conduct, and the centrality of a collaborative and developmental approach. The paper concludes that these features form a coherent approach to asset-based evaluation which can link the theory and practice of Asset Based Community Development.

This article reports the findings of a mixed-methods evaluation study on the impact of a national fund to support volunteering as a mechanism to achieve health and social goals, within the Health and Social Care Volunteering Fund (HSCVF) programme, established by the formerly named Department of Health (now the Department of Health and Social Care). The article adds understanding of the mechanisms through which government organisations can build voluntary, community and social enterprise (VCSE) organisational capacity to support volunteers. First, the programme increased capacity via resource mobilisation to enhance volunteer recruitment; second, it strengthened VCSE organisations through partnerships/linkages/networking; and finally, it supported learning and skills development. The HSCVF impacted on both volunteering projects and host organisations to produce a range of positive outcomes that were particularly marked in smaller organisations: 'small project, big difference'. Successful community capacity building can result from programmes such as HSCVF, with this article contributing to the evidence base by detailing the processes through which this occurred.

Abstract:
Health Champions are a growing component within the British public health workforce and their roles are now emphasised within the coalition's Government's public health strategy. However, there is the need for further exploration of the way in which Health Champions use interpersonal communication within their roles. This paper reports on the findings from a mixed method evaluation of one Health Champion programme in North East England. A key finding was the way in which Health Champions used circles of influence to communicate health knowledge and to try to achieve behaviour change, starting with themselves in the centre of their circle and then moving outwards to influence others such as family, friends and colleagues through their social networks. The paper argues that health champions act as healthy role models within their own circles of influence to successfully communicate health knowledge to those around them.

AbstractGrowing policymaker interest in community wellbeing puts a premium on knowledge about existing community-level challenges and possible policy responses. If evidence-based policy and practice is foregrounded in these developments, there is a risk that lived experience is seen to lack validity in policy-making decisions and that knowledge from and about underrepresented groups is underemphasised. In consequence, the best available evidence on which to make policy decisions affecting these groups might be missed, thus potentially increasing health inequalities. This paper extends debate on this dilemma in this journal by using the lens of 'pragmatic complexity' as an alternative view on what works as evidence for policy and practice in community wellbeing. We present an empirical analysis of two expert hearings about community wellbeing. The events used a deliberative approach, allowing participants to probe evidence and consider from multiple perspectives ideas of how to address identified issues. Two overarching themes from the hearings - a perceived gap between the rhetoric and reality of wellbeing evidence, and proposals on 'what works' in the (co)-production of knowledge about wellbeing – are articulated and explored. We develop specific features emerging from the hearings that have wider resonance for community wellbeing research and suggest potential responses: what counts as 'good' or good-enough evidence about community wellbeing; system responses requiring thinking and engaging with complexity; reflections on the collective and collaborative process of an expert hearing approach. The combination of analysis of knowledge generated deliberatively through an expert hearing approach and a pragmatic complexity lens, delimits our contribution.