This article analyses the development of the Council of Social Service for Wales during what is often called the Golden Age of the Welfare State. Recovering the neglected history of the peak organisation for voluntary social service in Wales adds to our understanding of the histories of social policy and postwar Wales. The article addresses social policy from a doubly peripheral perspective – it attends to a territorial periphery of the UK State while voluntary action can be left at the margins of Welfare State analysis. From this perspective we hope to cast new light on the historiography of the ‘British Welfare State’

The survey aims to assess the knowledge and awareness of Reimbursement Bodies (RBs) and Patient Advocacy Groups (PAGs) in Lebanon and the possible involvement of patients in the health technology assessment (HTA) process in the absence of a well-established HTA structure and to identify the actions to be taken at this level. Structured questionnaires were administered to eleven key participants from both RBs and PAGs. The survey utilized two different questionnaires, each composed of two open-ended questions and ten close-ended questions. RBs recognized the need for clinical and technical guidelines to optimize the HTA process, whereas PAGs stated that they are familiar with the current assessment and reimbursement process. A lack of interaction between the payers and the PAGs was reported mainly due to the absence of laws that involve patients in the assessment process. All the payers and three out of five of PAGs encouraged the involvement of PAGs in the assessment process. They reported that patients require support, education, and training to be efficiently involved. A short-term plan for involving patients in the assessment process can be implemented in light of RBs' and PAGs' openness for such involvement. In the long run, the collaboration between both parties needs to be more formalized and structured. Education and training programs are to be suggested for other PAGs. The institutionalization of an HTA body that unifies all the fragmented RBs, including a patient's representation to optimize the reimbursement process and to engage patients, is recommended.

The Munro Review of Child Protection asserted that the English child protection system had become overly ‘defensive’, ‘bureaucratised’ and ‘standardised’, meaning that social workers were not employing their discretion in the interests of the individual child. This paper reports on the results of an ethnographic case study of one of England’s statutory child protection teams. The research sought to explore the extent of social worker discretion relative to Munro’s call for ‘radical reform’ and a move towards a more ‘child-centred’ system. Employing an iterative mixed methods design – encompassing documentary analysis, observation, focus group, questionnaire, interview and ‘Critical Realist Grounded Theory’ – the study positioned the UK Government’s prolonged policy of ‘austerity’ as a barrier to social worker discretion. This was because the policy was seen to be contributing to an increased demand for child protection services; and a related sense amongst practitioners that they were afforded insufficient time with the child to garner the requisite knowledge, necessary for discretionary behaviour. Ultimately, despite evidence of progress relative to assertions that social worker discretion had been eroded, the paper concludes that there may still be ‘more to do’ if we are to achieve the ‘child-centred’ and ‘effective’ system that Munro advocated.

More and more studies indicate that leisure plays a fundamental role in active ageing. Our study describes the current leisure patterns of older adults, comparing them with other age groups. Consequently, 445 adults, stratified by age (young, middle-aged and older adults), were selected and subsequently administered a set of tests. The results indicate that older people claim having more time for their leisure activities; however, the diversity of activities performed is lower, showing a negative gradient based on age. The leisure patterns of older people reflect a predominance of passive leisure, little cultural leisure time and moderate levels of social and physical leisure activities. Older people’s leisure seems to be influenced by ageist stereotypes and attribution biases. Our findings imply that these results could be used to design and implement programs aimed at promoting leisure styles that contribute to increase active ageing.

While specialist women’s refuges have been central to responses to family violence since the 1970s, their work is under-researched. Little is known outside the family violence sector about the support they provide and how it assists women and children. There have been some critiques of their work but there is limited knowledge of the constraints women’s refuges face. Based on interviews and focus groups with 100 professional stakeholders and twenty-two service users, this article analyses the work of women’s refuges in the Australian state of Victoria in an effort to inform policy reform. The research found that refuges’ underpinning gendered analysis, focus on safety and support and advocacy to ensure women’s human rights are met have much to offer further developments in responding to family violence. In doing so, the article contributes to critical debates about the operation of refuges and the need for specialist family violence services.

The scarcity of medical resources is widely recognized, and therefore priority setting is inevitable. This study examines whether Portuguese healthcare professionals (physicians vs nurses): (i) share the moral guidance proposed by ethicists and (ii) attitudes toward prioritization criteria vary among individual and professional characteristics. A sample of 254 healthcare professionals were confronted with hypothetical prioritization scenarios involving two patients distinguished by personal or health characteristics. Descriptive statistics and parametric analyses were performed to evaluate and compare the adherence of both groups of healthcare professionals regarding 10 rationing criteria: waiting time, treatment prognosis measured in life expectancy and quality of life, severity of health conditions measured in pain and immediate risk of dying, age discrimination measured in favoring the young over older and favoring the youngest over the young, merit evaluated positively or negatively, and parenthood. The findings show a slight adherence to the criteria. Waiting time and patient pain were the conditions considered fairer by respondents in contrast with the ethicists normative. Preferences for distributive justice vary by professional group and among participants with different political orientations, rationing experience, years of experience, and level of satisfaction with the NHS. Decision-makers should consider the opinion of ethicists, but also those of healthcare professionals to legitimize explicit guidelines.

Drawing from theory and research on the role of social networks in promoting or undermining preventative public health measures, this article considers how structural, compositional and functional aspects of older adults’ close social networks are associated with HIV testing in the context of rural South Africa. Analyses use data from the population-based Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) – a sample of rural adults age 40+ (N = 4,660). Results from multiple logistic regression show older South African adults with larger, more heavily non-kin and more literate networks were most likely to report testing for HIV. People whose network members provided frequent information were also most likely to be tested, though interaction effects indicate that this pattern is primarily found among those with highly literate networks. Taken together, the findings reinforce a key insight from social capital perspectives: network resourcefulness – literacy in particular – is crucial for promoting preventative health practice. The synergy between network literacy and informational support reveals the complex interplay between network characteristics in shaping health-seeking behaviour. Continued research is needed on the connection between networks and HIV testing among sub-Saharan older adults, as this population is not currently well served by many public health efforts in the region.

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

The federal and Quebec governments are both considering extending medical aid/assistance in dying (MAID) to non-competent patients who would have requested MAID prior to losing capacity. In 2016–2017, we surveyed 136 Quebec physicians (response rate: 25.5%) on their attitudes towards extending MAID to such patients. Complementing our published findings, we herein identify demographic and practice characteristics that distinguish physicians who reported being open to extending MAID to non-competent patients with dementia, or willing to administer MAID themselves should it be legal, from those who were not. We found that physicians who were older, had stronger religious beliefs, were trained in palliative care, practiced in a teaching hospital, and had not received assisted dying requests in the year preceding the survey held less favourable attitudes towards MAID for non-competent patients with dementia. These findings will inform current deliberations as to whether assistance in dying should be extended to non-competent patients in some circumstances.

The purpose of this study is to assess the relationship between adult children's education and older parents’ cognitive health, and the extent to which this relationship is moderated by parents’ own socio-economic and marital statuses. Data using Waves 5 (2000) to 13 (2016) are drawn from the Health and Retirement Study (HRS), a nationally representative panel survey of individuals age 50 and above in the United States of America (USA). Older parents’ cognitive functioning is measured using episodic memory from Waves 5–13. Adult children's education is measured using years of schooling, on average, for all adult children of a respondent. Analyses based on multilevel linear growth curve modelling reveal that parents with well-educated adult children report higher memory score over time compared to their counterparts whose children are not as well-educated. We also find that the positive effect of children's education on parents’ cognitive health is moderated by parents’ own education, though not by their income, occupation or marital status. Our work contributes to the growing body of research on the ‘upward’ flow of resources model that assesses the ways in which personal and social assets of the younger generation shape the health and wellbeing of the older generation. Our findings are particularly relevant to the USA given the enduring linkage between socio-economic status and health, and the limited social and economic protection for those of lower social status.

I comment on Sunstein's paper proposing ‘Hayekian behavioural economics’. In essence, Sunstein is merely renaming a familiar approach to normative economics, initiated in Sunstein and Thaler's seminal 2003 paper. I argue that this approach cannot fairly be described as in the spirit of Hayek's work. Sunstein's approach is based on a ‘constructivist’ conception of rationality that Hayek consistently criticized. Although both Hayek and Sunstein address ‘knowledge problems’, the two problems are fundamentally different. I develop what I claim are truly Hayekian critiques of Sunstein's claim that fuel economy mandates can be more Hayekian than carbon taxes.

Nudging has become a well-known policy practice. Recently, ‘boosting’ has been suggested as an alternative to nudging. In contrast to nudges, boosts aim to empower individuals to exert their own agency to make decisions. This article is one of the first to compare a nudging and a boosting intervention, and it does so in a critical field setting: hand hygiene compliance of hospital nurses. During a 4-week quasi-experiment, we tested the effect of a reframing nudge and a risk literacy boost on hand hygiene compliance in three hospital wards. The results show that nudging and boosting were both effective interventions to improve hand hygiene compliance. A tentative finding is that, while the nudge had a stronger immediate effect, the boost effect remained stable for a week, even after the removal of the intervention. We conclude that, besides nudging, researchers and policymakers may consider boosting when they seek to implement or test behavioral interventions in domains such as healthcare.

Voluntary private health insurance (VHI) has generally been of limited importance in national health service-type health care systems, especially in the Nordic countries. During the last decades however, an increase in VHI uptake has taken place in the region. Critics of this development argue that voluntary health insurance can undermine support for public health care, while proponents contend that increased private funding for health services could relieve strained public health care systems. Using data from Sweden, this study investigates empirically how voluntary health insurance affects the public health care system. The results of the study indicate that the public Swedish health care system is fairly resilient to the impact of voluntary health insurance with regards to support for the tax-based funding. No difference between insurance holders and non-holders was found in willingness to finance public health care through taxes. A slight unburdening effect on public health care use was observed as VHI holders appeared to use public health care to a lesser extent than those without an insurance. However, a majority of the insurance holders continued to use the public health care system, indicating only a modest substitution effect.