Although research in partnership with older people has been slower to develop than that with some other service user 'groups', there are a growing number of health and social care studies that have involved older people as co-researchers. We build on this existing evidence by addressing two key areas. First, despite the growth of participatory research with older people generally, some groups tend to be excluded. We focus particularly on a project in which older people with dementia and older people from a black and minority ethnic community were involved as co-researchers. They worked with academic researchers in all stages of the research process, exploring other older people's experiences of transitions between care services. Second, recent literature suggests a lack of critical evaluation of involvement, arguing that researchers tend to emphasise the positives on the basis of retrospective narrative accounts of the process, rather than critically appraising the impact of involvement. This article offers a critical account of the impact of a participatory approach at different stages of a research project, evaluating this from the perspective of different stakeholders. In so doing, we engage with incisive critiques which claim that, far from empowering service users, much service user involvement activity contributes to their oppression. We conclude that participatory research with marginalised older people has the potential to achieve meaningful change at both individual and social levels. However, in view of its dangers

Social enterprises are being promoted as responsive and innovative way to deliver public services. As part of this promotion, these organizations are being required to demonstrate the social and economic value they generate. Social return on investment (SROI) is a performance measurement tool currently being encouraged to capture this impact. This paper draws on survey and interview data to analyse how SROI is used and understood in health and social care settings. It indicates that despite being accepted as an internationally recognized measurement tool for social enterprise, SROI is underused and undervalued due to practical and ideological barriers.

Recent years have seen a growth in research on retirement/lifestyle migration to Spain, however this has tended to focus on the reasons for moving, as well as the lifestyles adopted as part of a healthy and active retirement. However, ageing in Spain can bring challenges as a person's resources for independent living diminish. This paper draws on narrative interviews with vulnerable older British people in Spain, focusing on those who have encountered a severe decline in health, are frail and in need of care. It looks at the formal and informal networks and agencies that support these individuals, in particular the resources and strategies they employ to access care. Drawing on a framework of care provision developed by Glucksmann and Lyons, four broad modes of provision for old age care used by older British people in Spain are identified: state/public, family/community, voluntary/not-for-profit and market/for-profit. The paper argues that there are language, cultural, spatial and financial barriers when accessing care in Spain as an older British citizen. It is concluded that there are some frail, vulnerable people that may fall through a support gap, whereby they are no longer the responsibility of UK welfare services, yet not fully recognised in their new country of residence, and asks if more should be done to support this population.

BackgroundDecommissioning – defined as the planned process of removing, reducing or replacing health-care services – is an important component of current reforms in the NHS. However, the evidence base on which to guide policy and practice in this area is weak.AimThis study aims to formulate theoretically grounded, evidence-informed guidance to support best practice in effective decommissioning of NHS services.DesignThe overall approach is a sequential, multimethod research design. The study involves (1) a literature synthesis summarising what is known about decommissioning, an international expert Delphi study, 12 interviews with national/regional bodies and seven narrative vignettes from NHS leaders; (2) a survey of Clinical Commissioning Groups (CCGs) in England (n = 56/211, 27%); (3) longitudinal, prospective case studies of four purposively sampled decommissioning projects comprising 59 semistructured interviews, 18 non-participant observations and documentary analysis; and (4) research with citizens, patient/service user representatives, carers, third-sector organisations and local community groups, including three focus groups (30 participants) and a second Delphi study (26 participants). The study took place over the period 2013–16.SettingThe English NHS.ResultsThere is a lack of robust evidence to guide decommissioning, but among experts there is a high level of consensus for the following good-practice principles: establish a strong leadership team, engage clinical leaders from an early stage and establish a clear rationale for change. The most common type of CCG decommissioning activity was ‘relocation or replacement of a service from an acute to a community setting’ (28% of all activities) and the majority of responding CCGs (77%) were planning to decommission services. Case studies demonstrate the need to (1) draw on evidence, reviews and policies to frame the problem; (2) build alliances in order to legitimise decommissioning as a solution; (3) seek wider acceptance, including among patients and community groups, of decommissioning; and (4) devise implementation plans that recognise the additional challenges of removal and replacement. Citizens, patient/service user representatives, carers, third-sector organisations and local community groups were more likely to believe that decommissioning is driven by financial and political concerns than by considerations of service quality and efficiency, and to distrust and/or resent decision-makers. Overall, the study suggests that failure rates in decommissioning are likely to be higher than in other forms of service change, suggesting the need for tailored design and implementation approaches.LimitationsThere were few opportunities for patient and public engagement in early phases of the research; however, this was mitigated by the addition of work package 4. We were unable to track outcomes of decommissioning activities within the time scales of the project and the survey response rate was lower than anticipated.ConclusionsDecommissioning is shaped by change management and implementation, evidence and information, and relationships and politics. We propose an expanded understanding, encompassing organisational and political factors, of how avoidance of loss affects the delivery of decommissioning programmes. Future work should explore the relationships between contexts, mechanisms and outcomes in decommissioning, develop the understanding of how loss affects decisions and explore the long-term impact of decommissioning and its impact on patient care and outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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This article describes the organization and outcomes of a Rural Health Outreach Initiative (RHOI) designed to increase collaboration between the medical education and health care delivery sectors to improve the quality of health care delivery and health outcomes in rural communities. Two inter-related partnership strategies were utilized in rural communities to address the health and social service needs of rural populations. The partnerships were created through the efforts of a rural health professions education program located in a community-based medical school. The two partnership models were implemented at the same time and target the same rural populations. Both strategies relied upon interdisciplinary collaborations to achieve their goals and outcomes. One strategy involved the creation of partnerships among rural medical students and the projects they initiate, using the model of community oriented primary care (COPC). The second strategy involved the establishment of partnerships by a variety of rural, community-based entities that resulted from a three-year Health Resources and Services Administration Rural Health Outreach grant that supported a "mini-grant" program. This article summarizes the process and results of these innovative collaborations that occurred at two levels: (1) between health and service institutions representing multiple disciplines and (2) between academic institutions and local communities. Specific attention is given to projects that resulted from the work of the partnerships that address the needs of older adults residing in the rural communities. The two strategies are compared and implications for the success of similar efforts are discussed.

Since the end of the last century governments in many western welfare regimes have been keen to promote the marketisation of public service delivery. This requires changes in the supply of, and demand for, alternative providers in this market, and in particular for many governments this has included third sector providers. This article examines the attempt by the UK Labour government to promote the supply of social enterprises in the market for health and social care services in England, through the Social Enterprise Investment Fund (SEIF), introduced in 2007. The article reports on research evaluating the effectiveness of the SEIF, employing a 'theories of change' approach, drawing on a mix of administrative and survey data, qualitative interviews and case studies. The research found that although the SEIF had significant benefits in supporting the start up and growth of organisations, its contribution to their longer-term sustainability was more mixed as most were dependent on grants as a main source of income and were not in a position to compete for public sector contracts. This suggests that there may be limits to the role that public investment can play in such market making. Marketisation and social enterpriseThe reform of public services in the UK was one of the central themes of social policy development under the previous Labour governments, and has been taken up as a key priority by the Coalition government since 2010. Since the turn of the century, much of social policy in the UK has been devolved to the separate administrations in Scotland, Wales and Northern Ireland; however, this article focuses on developments in England only. This programme of reform is sometimes referred to as 'modernisation' (Margetts et al., 2010) or

Over the past few decades the policy environment in the UK has gradually sought to encourage public sector workers to 'spin-out