The UK Soft Drinks Industry Levy (SDIL) (announced in March 2016; implemented in April 2018) aims to incentivise reformulation of soft drinks to reduce added sugar levels. The SDIL has been applauded as a policy success, and it has survived calls from parliamentarians for it to be repealed. We aimed to explore parliamentary reaction to the SDIL following its announcement until two years post-implementation in order to understand how health policy can become established and resilient to opposition.

Searches of Hansard for parliamentary debate transcripts that discussed the SDIL retrieved 186 transcripts, with 160 included after screening. Five stages of Applied Thematic Analysis were conducted: familiarisation and creation of initial codebooks; independent second coding; codebook finalisation through team consensus; final coding of the dataset to the complete codebook; and theme finalisation through team consensus.

The United Kingdom Parliament

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Between the announcement (16/03/2016) – royal assent (26/04/2017), two themes were identified 1: SDIL welcomed cross-party 2: SDIL a good start but not enough. Between royal assent – implementation (5/04/2018), one theme was identified 3: The SDIL worked – what next? The final theme identified from implementation until 16/03/2020 was 4: Moving on from the SDIL.

After the announcement, the SDIL had cross-party support and was recognised to have encouraged reformulation prior to implementation. Lessons for governments indicate that the combination of cross-party support and a policy’s documented success in achieving its aim can help cement the resilience of it to opposition and threats of repeal.

Many conservation initiatives call for ‘transformative change’ to counter biodiversity loss, climate change, and injustice. The term connotes fundamental, broad, and durable changes to human relationships with nature. However, if oversimplified or overcomplicated, or not focused enough on power and the political action necessary for change, associated initiatives can perpetuate or exacerbate existing crises. This article aims to help practitioners deliberately catalyze and steer transformation processes. It provides a theoretically and practically grounded definition of ‘transformative conservation’, along with six strategic, interlocking recommendations. These cover systems pedagogy, political mobilization, inner transformation, as well as planning, action, and continual adjustment.

Calls for ‘transformative change’ point to the fundamental reorganization necessary for global conservation initiatives to stem ecological catastrophe. However, the concept risks being oversimplified or overcomplicated, and focusing too little on power and the political action necessary for change. Accordingly, its intersection with contemporary biodiversity and climate change mitigation initiatives needs explicit deliberation and clarification. This article advances the praxis of ‘transformative conservation’ as both (1) a desired process that rethinks the relationships between individuals, society, and nature, and restructures systems accordingly, and (2) a desired outcome that conserves biodiversity while justly transitioning to net zero emission economies and securing the sustainable and regenerative use of natural resources. It first reviews criticisms of area-based conservation targets, natural climate solutions, and nature-based solutions that are framed as transformative, including issues of ecological integrity, livelihoods, gender, equity, growth, power, participation, knowledge, and governance. It then substantiates six strategic recommendations designed to help practitioners deliberately steer transformation processes. These include taking a systems approach; partnering with political movements to achieve equitable and just transformation; linking societal with personal (‘inner’) transformation; updating how we plan; facilitating shifts from diagnosis and planning to action; and improving our ability to adjust to transformation as it occurs.

Curious about stemming the global biodiversity and climate crises? Browse this article on transformative conservation!

Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.

Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.

Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.

We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.

Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.

Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).

We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.

We conducted three interrelated activities to produce the TIER intervention:

• • Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use

• • Scoping review of literature describing prehospital care of patients with TIA

• • Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.

The panel used results to define the TIER intervention, to include:

1. 1. Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic

2. 2. Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic

3. 3. Referral process via ambulance control room

4. 4. Training package for paramedics

5. 5. Agreement with TIA clinic service provider including rapid review of referred patients

We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.